Save Money & Stay Compliant

When the claimant is a Medicare beneficiary or is in the “waiting period” for Medicare benefits.

When a claimant has a reasonable expectation of Medicare enrollment within 30 months or if any of the following apply:

The claimant has applied for Social Security Disability Benefits.

The claimant has been denied Social Security Disability Benefits but anticipates appealing that decision.

The claimant is in the process of appealing and/or re-filing for Social Security Disability benefits.

The claimant is 62 years and 6 months old.

The claimant has End-Stage Renal Disease (ERSD) condition but does not yet qualify for Medicare based upon ERSD.

We recommend that Medicare’s interests be considered whenever settling a workers’ comp or third-party claim involving future medical benefits. The Center for Medicare and Medicaid Services (CMS) reviews MSAs if:

· You are a Medicare recipient, and your total settlement exceeds $25,000; or,

· You are expected to become a Medicare recipient within 30 months of settlement, and your total settlement exceeds $250,000

Once the funds are legitimately exhausted, Medicare will pay for the future injury related care and does not require the recipient to reimburse Medicare for expenses related to the settlement

If the claimant is under 62.5 years old, has not applied for Social Security Disability Benefits and does not have end stage-renal disease. An MCP can be used to set reserves or to provide a tool for settlement negotiation. An MCP can later be converted to an MSA for a minimal fee.