Medicare Set-Aside : Very important:
set-aside for medical costs Medicare covers.
This another big subject for the iw that is waiting for a section 32 settlement and has SSD. I just talked to an iw worker that just finished up with the set aside with SSD/med. again it takes time about 6 months for SSD to set up the set aside.
The WCMSA proposal is sent to CMS/Medicare for review and approval. YOu will receive a letter once CMS has made the determination Medicare interests have been protected. If the proposal is not sufficient in CMS eyes... they will adjust the amount, and whether you or the carrier likes it or not.. there is no dispute to CMS.
Those numbers stand.
At that point, you can't force them to cough more money... if they won't fund the setaside, you can use some of your money, or wait.
The WCMSA should have been done BEFORE any dollar amount were negotiated...and include money for you to pay for services that Medicare doesn't cover. There is the potential for significant out of pocket costs... yours.
CMS depending on the backlog at RO/Regional Offices can take up to 6 months to review a MSA>.. IF they choose to review.
You don't have to wait for CMS... but the settlement isn't finalized until they get the documents, and approve the set aside proposal. you don't "setaside" money for SSDI considerations.. you must notify SSA of any change in your financial status..but that refers to earned income.The WCMSA proposal is sent to CMS/Medicare for review and approval. YOu will receive a letter once CMS has made the determination Medicare interests have been protected. If the proposal is not sufficient in CMS eyes... they will adjust the amount, and whether you or the carrier likes it or not.. there is no dispute to CMS.
Those numbers stand.
At that point, you can't force them to cough more money... if they won't fund the setaside, you can use some of your money, or wait.
The WCMSA should have been done BEFORE any dollar amount were negotiated...and include money for you to pay for services that Medicare doesn't cover. There is the potential for significant out of pocket costs... yours.
You can ONLY use the money in your WCMSA for services...treatment, medication etc, that Medicare would normally pay for.
There could be huge out of pocket costs if a medication you are taking were dropped from the Medicare Approved Drug formulary. Even if there is a medication you are taking now... Medicare could drop that next year and you'd have to pay out of pocket.
There are caps Medicare pays for in hospital stays... you need to go to www.medicare.gov and do some research on what Medicare pays for, and what they don't.
When you submit a WCMSA proposal to CMS for review, they don't care about anything Medicare doesn't pay for.
The money in a MSA is accountable to CMS yearly. The non MSA money is not accountable to CMS... that money can be much more important than the WCMSA dollars.
https://www.cms.gov/workerscompagenc...wcsetaside.asp