Medicare Set Aside Agreement: What You Need to Know
When it comes to settling personal injury claims, Medicare Set Aside (MSA) agreements have become increasingly important. An MSA is a legal agreement between a plaintiff and the Centers for Medicare and Medicaid Services (CMS) that outlines the amount of money that should be set aside from a settlement or judgment to cover future medical expenses related to the injury.
Why is an MSA necessary?
The reason an MSA is necessary is because Medicare is considered a secondary payer. This means that Medicare will not pay for medical expenses that have been or will be paid by another insurance provider. If a plaintiff receives a settlement or judgment to cover medical expenses related to their injury, they are responsible for reimbursing Medicare for any related medical expenses that were paid by Medicare.
If the plaintiff fails to reimburse Medicare, they can face significant penalties, including fines and even imprisonment. To avoid these penalties, an MSA is necessary. The MSA outlines the amount of money that should be set aside from the settlement or judgment to cover future medical expenses related to the injury. This money is placed in a special account and is used to pay for medical expenses related to the injury before Medicare begins paying for these expenses.
Who determines the amount of the MSA?
The amount of the MSA is determined by taking into account the expected future medical expenses related to the injury. This includes the cost of medications, medical equipment, therapy, and any other medical services related to the injury. A medical expert is usually consulted to help determine the amount of the MSA.
Once the amount of the MSA is determined, it must be approved by the CMS. This can take several weeks or even months, depending on the complexity of the case.
What happens if the MSA is not used up?
If the MSA is not used up, the plaintiff can request a refund of any remaining funds. However, the plaintiff must provide proof that the funds were not used for medical expenses related to the injury before the refund can be issued.
In conclusion, an MSA is a necessary component of many personal injury cases to ensure that Medicare is properly reimbursed for any medical expenses related to the injury. If you are involved in a personal injury case and are required to enter into an MSA agreement, it is important to work with an experienced attorney who can help guide you through the process and ensure that your rights are protected.