The CMS has outlined when and how Medicare's interests should be protected. If the primary payor is settling future medical benefits for a "qualified individual, allocation must be made to cover future injury related Medicare allowable expenses to prevent the shifting burden to Medicare. This arrangement is referred to as an Medicare Set-Aside (MSA). An MSA must be approved by CMS.
MSA accounts. Medicare continues to seek past paid Medicare benefits through liens and is not subject to the Ahlborn decision. Medicare requires an MSA account in all Worker's Compensation case with a preset amount to pay future medical expenses. The law now requires a specific portion of a settlement from certain third party liability claims be placed in an MSA to be used exclusively for future injury-related medical expenses otherwise paid by Medicare.
To qualify for an MSA account, the client must be a Medicare recipient at the time of settlement. A client may also qualify if he or she is not currently receiving Medicare, but the total amount of the settlement is over $250,000, and the client would reasonably be expected to qualify for Medicare within 30 months of the settlement.