Medicare Set-Aside Allocation

CLICK TO READ the Medicare White Paper by Daniel J. Santaniello, Director FDLA and Reinaldo Alvarez, Member. This article was orginally published in Trial Advocate Quarterly.

We offer Medicare set-aside allocation services, medical cost projection services and CMS submission services in cases involving a qualified claimant. MSAs are structured settlements, which over time set-aside specific monies for a plaintiff’s medical bills.

As part of an MSA, a detailed evaluation of a recipient’s anticipated future medical expenses is completed. Various factors including the recipient’s life expectancy, the future costs of prescription medications, future surgeries, therapy, durable medical goods, etc. are all considered and calculated to project an annual cost of the anticipated future medical care. A portion of the settlement is then “set aside” to cover these future expenses. In cases where significant future expenses are anticipated, an annuity may be purchased to fund the MSA. It is the responsibility of the recipient to monitor and administer the funds that have been set aside by the MSA, although a trust can be created if needed.

Any funds that are not exhausted for a given year are then carried over to the next year. After a period of five years, a recipient can petition CMS to amend or dissolve the MSA if the actual medical benefits are lower then what was outlined in the original MSA.

Our MSA Services include:

• A review of all medical records;
• Preparation of an MSA allocation and cost projections;
• Projection of both allowable and non-allowable Medicare costs over the Plaintiff/Claimant's life expectancy;
• Projection of the future pharmaceutical costs;
• A review of the Claimant/Plaintiff's Social Security and Medicare status;
• A determination of the Claimant/Plaintiff's Medicare conditional payment status.