How Are Medicare Set-Aside Portions of a Settled Claim Reported?


Quick Answer

The Centers for Medicare and Medicaid Services, or CMS, recommends submitting the settlement details regarding a Workers' Compensation Medicare Set-Aside Arrangement using the agency's web portal or by mail. It is not a requirement to submit this information for review, and the CMS only reviews settlements for more than $25,000 for claimants already receiving Medicare, or $250,000 if the claimant reasonably expects to receive Medicare within 30 months of the settlement date, according to the CMS.

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Full Answer

When the parties in a workers' compensation case agree on a settlement amount, Medicare Secondary Payer laws require them to set aside a portion of this money to cover future medical expenses related to the claimant's injury, illness or disease, explains the CMS. Medicare does not pay for medical services related to workers' compensation cases as long as these funds remain available, and the fund must be of a sufficient size. This requirement helps protect Medicare financially, and all parties in the case bear responsibility to ensure this protection. The CMS recommends the use of a Workers' Compensation Medicare Set-Aside Arrangement, or WCMSA, to set up this funding and offers to review the details of the arrangement to determine if the fund is sufficient. The actual amount of money necessary varies depending on the details of the case.

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