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What is a Workers’ Compensation Set-Aside Arrangement?

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A work-related injury can turn your world on its head. You might be wondering how to pay for your medical bills or compensate for your lost wages. The worker’s compensation programs provides valuable recourse to workers by having employers pay for medical bills and a portion of lost wages when an employee sustains an injury on the job. Sometimes, though, an injury may take months or even years to fully recuperate, and the most severe injuries can lead to permanent disability. When a workplace injury leads to the need for long-term care, the Workers Compensation Medicare Set-Aside Arrangement can provide valuable assistance.

Set-Aside Arrangement

A Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) is a monetary agreement that funnels a percentage of a worker’s compensation claim to pay for future health expenses that are related to an occupational illness, injury, or disease. A claimant must use these funds prior to Medicare kicking in, which pays for treatment of an occupational condition.

Everyone involved in a worker’s compensation case must follow the Medicare as a Second Payer Laws. This helps protect Medicare’s funds and interests. The recommended method for protecting these interests is a WCMSA.

By law, Medicare is always a “secondary payer,” which means they will only pay if there is no other insurance available. In the event of a workplace injury, worker’s compensation insurance is generally available. This helps minimize the burden on the taxpayers and helps sustain Medicare funds.

How Much Will I Get?

The amount of a WCMSA settlement depends on the individual context of the case. After you get a settlement in a worker’s compensation or personal injury case, a certain amount must be set aside in a separate account for future medical expenses. Once you spend all the money in your MSA account for qualified expenses following the proper rules for reporting, Medicare will kick in and pay for your medical care.

A WCMSA makes every attempt to calculate every future medical expense that might be related to your illness or injury. It includes money for:

  • Prescriptions
  • Surgeries
  • Diagnostic tests
  • Doctor’s visits and copays
  • Medical supplies and equipment

What Are The Reporting Rules and Regulations?

All WCMSA accounts must follow certain reporting and recordkeeping guidelines in accordance with the Centers for Medicare and Medicaid Services. There are also restrictions regarding how the money can and cannot be used. You must keep all copies of records and receipts and report all expenses to Medicare. Any mistake could result in losing Medicare as a secondary payer. It’s essential that you follow all rules and keep up with your reporting with the CMS so you can receive timely payment for your medical treatments when the WCSMA runs out.

A WCSMA can be a valuable asset to an injured worker, though you must monitor your accounts carefully. Only use the money for approved expenses. If you follow all the rules closely, you will be able to accept Medicare as a secondary payer and obtain compensation for your medical bills.