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What is a Medicare Set Aside

What is a Medicare Set Aside

In a previous blogs we discussed how drawing workers’ compensation benefits could lead to a “set off” of Social Security disability benefits you might otherwise have been entitled to, and we explained how an offset could effect your disability benefits even if you settle your workers’ compensation claim absent the correct legal language; but, if as part of the settlement of your workers’ compensation benefits you agree to accept money to close your right to future medical treatment for the injuries you sustained in your job related injury-you must also consider Medicare’s interests; this is typically done via a Medicare Set Aside.

Once it has been decided that you are entitled to Social Security disability benefits, you will generally become entitled to Medicare benefits 29 months after the date it was determined that they became disabled, but Medicare is a “secondary” payer, which means that if any other insurance provider is supposed to pay for your medical treatment, then Medicare will only cover that amount which the primary insurance carrier does not pay.  In Alabama workers’ compensation cases, the workers’ comp insurance carrier is legally obligated to pay any and all “reasonable and necessary” medical expenses-which means Medicare will not pay for any treatment which is the responsibility of workers’ compensation UNLESS Medicare has agreed to the terms of the settlement of your right to future medical benefits though a Medicare Set Aside.

To be safe, a medical trust account called a “Medicare Set-Aside” needs to be set up.  A detailed analysis of what your future medical expense can reasonably be expected to be has to be performed and presented to Medicare for approval.  If approved, then workers’ comp can pay the injured worker a lump sum to close their right to future medical benefits, but they will also be responsible to make annual payments to the Medicare Set-Aside account.  From an approved account, the disabled worker is to use a set amount of the funds in the account for treatment related to the workplace injury; after the agreed amount is spent each year, Medicare will pay any other related expenses.  It is generally the injured worker’s responsibility to maintain a correct accounting of the money spent from the Medicare Set-Aside account.

For seriously injured workers, Social Security Disability benefits may be available, and in those situations, it is vital to have a lawyer experienced in handling both Alabama Workers Compensation and Social Security Disability cases-as what happens in once case could have a lasting impact on the other.

If you are employed in Alabama and have suffered a job injury and you have questions about your right to Alabama Workers Compensation benefits, of if you have been denied Social Security Disability benefits or SSI benefits, don’t hesitate to call and speak with one of the experienced attorneys at Powell and Denny today for a free consultation. Appointments are available in person, or virtually via Zoom if more convenient.

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What is a Medicare Set Aside

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