What Is a Medicare Set-Aside (MSA)?
A Medicare Set-Aside Account (MSA) is a special fund used to pay for future medical treatment related to an injury after a settlement. If you’re receiving a settlement from a workers’ compensation or personal injury case, and Medicare might be responsible for some of your future healthcare, you may need an MSA to protect your benefits.
The goal of a Medicare Set-Aside is simple: to make sure that settlement money is used first to cover injury-related medical expenses—before Medicare steps in to pay.
How Does a Medicare Set-Aside Work?
Before your case is settled, a qualified professional will review your medical needs and estimate how much should be set aside for future treatment. This amount is then:
Placed in a dedicated account, either as a lump sum or through a structured annuity (paid out over time), and
Used only to pay for medical care related to your injury that would otherwise be covered by Medicare.
The account is monitored, and once it’s properly used up, Medicare may resume coverage for related care.
Who Needs a Medicare Set-Aside?
While Medicare Set-Asides have long been required in workers’ compensation cases, they are becoming more common in personal injury settlements as well.
You may need a Medicare Set-Aside if:
You are already on Medicare and your settlement is over $25,000, or
You are expected to qualify for Medicare within 30 months (for example, you’re on SSDI), and your settlement is over $250,000.
Even when not strictly required, setting up an MSA can help you protect your future Medicare eligibility and avoid legal complications.
Why It Matters
If Medicare isn’t properly reimbursed—or if the MSA rules aren’t followed—Medicare can deny payment for future care, or even demand repayment from you, your attorney, or your insurance company.
As your legal advocate, we ensure that Medicare’s interests are properly addressed and that you stay protected.
Need Help With a Medicare Set-Aside?
We work closely with trusted vendors to evaluate, establish, and manage MSAs, and guide you every step of the way through the settlement process.
📞 Contact us today to schedule a consultation and learn how we can protect both your benefits and your peace of mind.
