What is a Workers’ Compensation Medicare Set-Aside Arrangement?

Read this article to learn more about Workers’ Compensation Medicare Set-Aside Arrangements (WCMSA).

Medicare Secondary Payer (MSP) laws require that Medicare's interest be protected in workers' compensation cases involving awards of future medical expenses for services related to workers' comp injuries, illnesses or diseases. A Workers' Compensation Medicare Set-Aside Arrangement (WCMSA) is the recommended method by which Medicare's interests can be protected.

The purpose of the arrangement is to protect Medicare's interests by stipulating that a certain portion of the workers' comp settlement will be allocated to pay for future, workers' comp-related medical expenses and that the set-aside funds will be depleted before Medicare will pay for any covered medical treatment or prescription drugs.

While there are no specific statutory requirements for when a WCMSA must be submitted, it is a recommended process. However, according to the Centers for Medicare & Medicaid Services (CMS) website, CMS will only review WCMSA proposals that meet the following criteria:

  • The workers' compensation claimant is both a recipient of Medicare (a Medicare beneficiary) and the total workers' comp settlement amount is greater than $25,000
  • The workers' compensation claimant has both a "reasonable expectation" of enrolling in Medicare within the next 30 months of the date of the settlement and the total anticipated amount of the workers' comp settlement for future medical expense, disability and/or lost wages is expected to be more than $250,000.

There is no set amount for the WCMSA. Each case is determined individually, on its own merits.

Speak to a Maryland workers' compensation lawyer

To learn more about WCMSAs, call Cohen, Snyder, Eisenberg & Katzenberg, P.A., today at 443-529-0795 or contact us online to schedule a free initial consultation and get our workers' comp attorneys on your side. One of our lawyers can work with you to obtain your workers' comp settlement and to set up a Workers' Compensation Medicare Set-aside Arrangement (WCMSA), if necessary. We have offices in Baltimore and four other Maryland locations.