• What is a Medicare Set-Aside and how does it Affect the Settlement of my Case?
  • August 19, 2014 | Author: Joseph A. Miller
  • Law Firm: Joe Miller Law, Ltd. - Norfolk Office
  • When you are injured in a work-related accident and you are on Medicare at the time or expect to be on Medicare in the near future, Medicare set-asides are something you need to keep in mind. In this article we will define what Medicare set-asides are and why it is important in your workers compensation case.

    What is a Medicare Set-Aside?

    Medicare set-asides (MSA’s) can be a bit confusing. Basically, when you are injured in a work accident while you are on Medicare or while you are qualified for Medicare, (or when you reasonably expect to be on Medicare in the near future) the Medicare set-aside makes it so that you cannot get a double recovery.

    An example of a double recovery would be if you were injured in a work accident and received a lump sum of money in a settlement and then tried to use your Medicare to cover your treatments for the work-related injuries. Because this is not allowed, you have to take your future medical needs into consideration during settlement to figure out what treatments you will need for the remainder of your life for your work injuries.

    Medicare Set-Aside Report

    Due to the fact that it is very hard, if not impossible, to predict the future, the way that the insurance company figures out what your future medical expenses will be is to order a Medicare Set-Aside Report.

    This report is done by a medical expert who will go through all of your medical records and come up with an estimated yearly cost for your future medical treatments. The estimate includes costs for doctor’s appointments, prescriptions, surgeries, injections, etc... The report will also include a lump sum estimate for the entire amount of Medicare-covered expenses that are likely to occur over your lifetime due to the work-related injury.

    The report is then sent to the Federal Medicare Office for approval.


    Usually the employer agrees to pay the lump sum estimated in the report as part of your settlement. They will do this through an annuity or a direct payment to you. If there is a settlement, then the estimated amount will be required to be set aside in a separate account for you to use in your future treatments only. You or the administrator of the account will be responsible for keeping track of your receipts and reporting yearly payments to the Federal Medicare Office.

    If you have been injured at work and you are currently on Medicare, or will be in the near future, you need an attorney who understands Medicare Set-Asides and who can help you through the process of your case. Joe Miller has been helping severely injured workers for over 25 years. Let Joe Miller put his many years of experience to work for you to get you the Strong Justice SM   you deserve.