Call For A Free Consultation
702.600.6000

Medicare Set-Asides: What the Law Means

Medicare Set-Asides: What they Mean to Personal Injury Attorneys & their Clients.

President Bush executed the Medicare Medicaid and SCHIP Extension Act known as MMSEA. This new law made changes to the governmental insurance programs providing health care benefits to those in need. Medicare often acts s a secondary payer and sometimes the primary payer of medical expenses as they relate to accident victims. Health insurance companies and 3rd party subrogation parties must notify Medicare and the US government of any potential liens owed to Medicare.

In the context of personal injury, Medicare will be the secondary payer, but not the first. The at-fault party must pay. The issue becomes what about “future “ medical expenses? Once a case settles, the victim may be eventually become a burden to Medicare when the damage was caused by a 3rd party. This new fairness doctrine is becoming more important to those who practice personal injury law. Shockingly, MMSEA does not require or have guidelines mandating Set-asides in liability style cases.

In worker’s compensation cases, there are some guidelines to practitioners on whether set asides are necessary: 1.) The injured party is a Medicare beneficiary and the case settles for more than $25,000.00, or the injured party is reasonably expected to be a Medicare beneficiary within 30 months of the date of the settlement, and the amount of the settlement is over $250,000. The calculation of a set aside includes two years of medical bills and a worker’s compensation history. A life care plan is then compiled and this is used to determine eligibility. A structured settlement can be utilized to lessen the burden on the victim while maximizing the payments back to Medicare.

A prudent attorney should also protect his injured client in the context of a strict 3rd party claim using the above formula for workers compensation cases to avoid any lack of future coverage for your client. Medicare is only allowed to assert liens on past medical damages for services rendered that actually are part of the liability claim. Often this takes an analysis of the medical expenses to decipher what medical treatment is related to the 3rd party claim. Call Benson & Bingham today if you have questions regarding your accident case.

If you have specific questions contact Benson & Bingham regarding your medical expenses.