Medicare Set Asides FAQs

Guardian MSA Tampa
What is a Medicare Set-Aside?

A Medicare Set-Aside is a required account that is entirely funded for future injury/illness related Medicare expenses which is Federally mandated for those individuals who meet the necessary qualifications.

Why has the Federal government mandated individuals to obtain an MSA?

The Federal government has required certain individuals to shift the burden of responsibility of work related injuries and illnesses from Medicare to the rightful primary payer who is either the Employer/Carrier or funds contributed by the Employer/Carrier to the Claimant or injured individual in any settlement.

What individuals are effected by the Federal Government’s mandate and are required to obtain an MSA?

You qualify for an MSA if 1) you are a Medicare recipient at the time of settlement or 2) you have a reasonable expectation of obtaining Medicare status within 30 months of the settlement date AND the anticipated total settlement amount for the entire claim is expected to be larger than $250,000.00.

Is an MSA required when dealing with general liability claims?

According to the most recent information from the Center for Medicare Services, there is no CMS review threshold when dealing with liability in the liability claims like those thresholds that are required for workers’ compensation claims. However, many clients choose to obtain a Liability MSA as a voluntary way to show the parties are still abiding by the Medicare Secondary Payer Act. Additionally, the formatting for the MSAs assists the parties in obtaining an accurate assessment for future medical needs of the injured party.

Although there is no required submission for liability MSAs, there are CMS regional offices that will review the MSA on a discretionary basis where the settlement amount for future anticipated medical expenses is quite high.

When can I expect the turn around time to be for my MSA?

At Guardian MSA we know that there are times when it is imperative to have the information and assessment as quickly as possible. Accordingly, we work hard to have our Medicare assessments to the requesting party within ten (10) days of receipt of the required information. However, the order can always be rushed when it is appropriate.

When will CMS approve the MSA?

When dealing with the Federal Government it is difficult to give and exact time frame in which we will have a response from CMS. This submission and approval process varies depending on the type of plan at issue and the venue in which we are working. It is possible to have a response in as quick as 30 days. However, this process usually runs longer if additional information is required and the volume of submissions is high.