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Is a Self-Managed Medicare Set Aside Right For You?

29 Oct 2015

In certain circumstances, Medicare requires personal injury and workers comp victims to set up a fund that is sufficient to satisfy the future medical expenses expected at the time of your settlement. Your future medical expenses and funding of the Medicare Set-Aside (MSA) are both approved by Medicare. If your medical expenses exceed the approved amount by Medicare, then Medicare will pick up and start paying where your MSA left off. But you should look long and hard at whether a self-managed Medicare Set Aside is right for you. Here are a couple of things you must be/do before you agree to self-manage your MSA.

1. You have to be a records keeper

If and when the MSA funds run out, you will need to look to Medicare to fill in the gaps and pay for medical treatment that is reasonable and necessary. But in order for Medicare to start paying, you have to present your accounting and supporting documentation to justify the depletion of those funds. Without the accounting and supporting documentation, Medicare will not pay.

2. You have to be a disciplined spender

You absolutely cannot use the MSA account as a slush fund for whatever new product that is out on the market. If you take money out of the account, you’ll have to put it back from your own funds. When this happens, you might think it unfair. But when you rob Peter to pay Paul, you ended up bearing the responsibility to pay Peter back.

3. You have to be accountable to the federal government

Your annual accounting will justify whether Medicare will pick up and pay for any of your medical expenses. Many people don’t want to tell the federal government any more than absolutely necessary. However, you will have to completely inform the federal government regarding this account. If that strikes you wrong, then perhaps a MSA is not for you.

4. You have to actively manage your physical condition

It is your responsibility to manage your injuries and treatment. You should keep your follow-up appointments and, if you are in pain management, comply with your pain contracts. You should fill and take your prescriptions and meet with the doctors to determine what, if anything, should be adjusted. There should always be a paper trail showing why you got the last treatment. Just because your personal injury case is over and your MSA is funded, that doesn’t mean that you have the right to not get the treatment you need.

If you can commit to doing all of these things, then a self-managed MSA might be right for you. If you struggle with any of these items, then you risk a substantial loss when it comes to Medicare paying your medical expenses when the money runs out.

You should discuss the intricacies of MSA’s in deep detail with your attorney before deciding to manage your own. For a consultation, submit an internet inquiry or call me.

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Brandon and his team at Osterbind Law are truly peerless. This is exactly how a modern personal injury firm should operate. The firm is holistic in its approach and thoughtful. It's no wonder why they get such great results for their clients. And no surprise, their clients love them. I've had the pleasure of working with Brandon on a professional level and he levels up, big time. Kudos.
Nathaniel Amendola
3 months ago

Very compassionate and knowledgeable people who helped us with our situation. They worked quickly and I can’t tell you how grateful I’m they were so caring. I would recommend this firm to anyone that anyone
Lori Rudder
a year ago

The entire team at Osterbind Law are incredible. They communicated with us with every step and process that was happening . They provided the knowledge, support, and empathy to us on the case. And when the curve ball was thrown, they dug in deeper. I have nothing but the highest respect for Brandon and Hannah and the entire team. They made us feel more like a family, than a client.
Wendy Shull
a year ago

The staff is caring and very knowledgeable. They help you as quickly as possible, and worked very hard for us. I'm so pleased with the way they assisted us.
Meghan Rudder
a year ago

Brandon and his team did a great job helping me through my case. I'm so glad I chose him and stuck with him through the transition to his own firm. The staff is very knowledgeable and friendly. They feel like family after all this! Thank you for everything!!Amber J
Amber Higby
2 year ago
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