Medicare Set-Aside

Medicare Set-Aside

The Medicare Secondary Payer Act of 1980 provides Medicare as the secondary payer and will not make payments if payments are being made, or will be made, under a State workers’ compensation act.

If a workers’ compensation lump sum settlement stipulates the amount paid is intended to pay for all future medicals, Medicare payments for future medical will be “excluded until medical expenses related to the injury or disease equal to the amount of the lump sum payment.” In other words, a lump sum settlement must allocate sufficient funds to cover a workers’ future medical expenses. A portion of the settlement must be set-aside to cover future Medicare covered medical expenses.

A Medicare Set-Aside Arrangement must be completed and approved by the Centers for Medicare and Medicaid Services (CMS) when

  • The injured worker is currently a Medicare recipient.
  • The injured worker is likely to receive Medicare within 30 months of settlement date.
  • The total amount of the settlement is over $250,000 (excluding attorneys’ fees).

Care Management Consultants, Inc., provides assistance to the disabled individual to maximize access to their future medical, vocational, rehabilitational, and financial planning needs. These services are designed to be cost-effective, jurisdictional specific, and provides information to assist all parties work together to promote appropriate financial resolution for each case.

Due to the recent enhancement of the Medicare Secondary Payer Act, Care Management Consultants, Inc., provides medical review services to meet the needs of our clients, insurance companies, third party administrators, employers, attorneys, brokers, etc.