If you are 65 or older, or are eligible for Medicare due to disability, this is a factor which needs to be carefully considered before you enter into any agreement to settle your workers’ compensation claim. This is due to the fact that CMS, the Centers for Medicare and Medicaid Services, takes steps to protect itself from paying for medical treatment in the future that they view as the responsibility of the workers’ compensation insurance carrier.
Often, a final resolution of these claims will require the establishment of an MSA or Medicare Set-Aside account. This is a separate set of funds that is designed to cover the future medical expenses associated with a work-related injury, and should be used only for that purpose. These funds are separate from funds that are payable to the injured employee, and must be maintained in a separate account.
The MSA can usually be either self-administered, with the employee doing their own administration and bookkeeping of the funds; or it can be professionally administered by a private company. These companies are familiar with Medicare rates for payment and other considerations for disbursing the MSA funds. The amount of the Medicare Set-Aside typically has to meet with Medicare’s approval as being sufficient funds to protect the future interests of CMS.
In addition to the need to carefully consider whether or not an MSA is necessary and if so, how to administer it, there are often concerns with ongoing workers’ compensation claims and Medicare. For example, if Medicare has made payment for any injury-related medical treatment that a workers’ compensation insurance carrier was obligated to pay, they will have a right to repayment of those funds. It is important to resolve these issues in order to deal with any efforts CMS may make to collect repayment.
There are multiple different considerations for Medicare-eligible employees who have suffered from work injuries. If you have had a work-related injury and are a Medicare beneficiary or anticipate being a Medicare beneficiary soon, contact our office for a free consultation regarding your rights.