What Are the Instructions for Creating and Administering a Medicare Set-Aside Trust?


Quick Answer

To create and administer a Medicare Set-Aside Trust, also known as a Workers' Compensation Set-Aside Arrangement, or WCMSA, a worker who receives a compensation settlement sets aside a portion of the funds and uses them only for Medicare-approved medical expenses for the injury that prompts the settlement, reports Medicare.gov. Medicare pays for medical services related to the injury only after depletion of the WCMSA. Workers can self-administer a WCMSA or hire professionals, states the Centers for Medicare and Medicaid Services.

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Full Answer

Workers can use funds they place in a WCMSA for medical services and prescription drugs that Medicare normally covers, explains Medicare.gov. They cannot use the funds for any medical problem unrelated to the settlement or for any expenses that Medicare does not normally pay. Workers should contact Medicare for verification before using WCMSA funds if they are uncertain whether Medicare covers the service or item. They should keep comprehensive records of medical expenses as proof that they correctly spend WCMSA funds.

Workers can submit WCMSA proposals for review through a portal on the CMS.gov website if the proposals meet specific criteria, according to the Centers for Medicare and Medicaid Services. CMS reviews proposals from claimants with settlements of more than $25,000 who already receive Medicare. It also reviews proposals from claimants with settlements of over $250,000 who plan to enroll in Medicare within 30 months of the date of the settlement.

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