Determine whether a set-aside is needed

An injured worker who is, or soon may become a Medicare beneficiary may need to have a Medicare set-aside created to assure Medicare's interests are taken into account. But not every workers' comp settlement requires a set-aside.

"It is not in Medicare's best interest to review every workers' comp settlement nationwide in order to protect Medicare's interests," according to the Centers for Medicare and Medicaid Services.The agency says a workers' comp Medicare set-aside arrangement may be submitted for review in either of the following situations:

The claimant is currently a Medicare beneficiary and the total settlement amount is greater than $25,000.
The claimant has a 'reasonable expectation' of Medicare enrollment within 30 months of the settlement date and the anticipated total settlement amount for future medical expenses and disability/lost wages over the life or duration of the settlement agreement is expected to be greater than $250,000.

December 5, 2011

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Medicare set-asides: Attorney outlines changes, reviews challenges (12/05/11)
Psychosocial issues are key to insurer's new modeling tool (09/29/11)

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