Blog Post

Professional MSA Administration v  Do It Yourself

John Darer • Nov 13, 2019

Professional Medicare Set Aside administration so cheap it's nuts to do it yourself

Administering a Medicare Aside

What is a Medicare Set Aside account?

A Medicare Set - Aside Arrangement (MSA) is an allocation of a portion of a workers' compensation, liability, or no-fault settlement, to pay for future medical expenses related to a workers' compensation injury, illness, or disease, or the injury, illness or disease arising out of the accident or incident that gave rise to a workers comp, liability or no-fault claim..

What happens if I don’t properly manage your MSA account?

If you do not properly manage your MSA account, you could severely jeopardize Medicare paying for your future medical care related to your accident or workers comp injury. Consequences include: denial of future bills from Medicare if your funds exhaust and being required to repay your MSA account for expenses that were paid for that are not covered by Medicare. Medicare reserves the right to have reporting for up to the entire settlement amount on Medicare covered treatments before Medicare agrees to begin covering injury-related bills.

If the injured party doesn’t properly manage their MSA account, Medicare will deny paying for their injury-related treatment until the reporting is corrected. To do so, the injured party will have to pay back any amount that was used on an improper expense not relating to their injury back into the MSA account.

Mismanaging the MSA account will jeopardize the injured party’s future Medicare benefits; for this reason, it’s important to be careful and seek assistance. Medicare “highly recommends” the use of a professional administrator. So do we.

Professional Administration is relatively cheap and they do the heavy lifting

Companies like Ametros will do it at $1,000, one and done! Similar with Medivest. If the insurer is high volume it ay be possible to negotiate a discount. Unless you have a tiny set aside, professional administration is a no-brainer. Do you really want to (1) determine if something is covered by Medicare (2) make sure that you're spending at the Medicare cost (3) be responsible for determining all of this before or at the point of service (4) be responsible for all filings with the Benefits Coordination and Recovery center (BCRC). Furthermore professional administrators give you a card just like you're used to with your medical insurance, they onboard your doctors and give you more time for you.

Want to learn more about Medicare Set-Aside? Read our MSA web page


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