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Medicare Set Aside
#1
Hello:

I recently settled the medical portion of my case by C&R. I settled my benefits part a couple of years ago.

I got 2 checks from the IC. One check was for the amount that Medicare approved for the Set Aside (broken down into 2 amounts, services and procedures covered by Medicare, and another amount for prescriptions.

This check is very straight forward with clear instruction on how to use the money.

The 2nd check I got is very much less clear and the one I have the questions about"
It is to pay for items Medicare doesn't cover ie mileage, a driver, co- pays etc

I am unsure whether I can deposit this check in the account. I created for the MSA. Or do I need to create a second checking account just for this check?

I am also assuming that I will run out of funds in the MSA for services faster than I will run out of funds earmarked for medication.

When this happens do I start using the funds in the non MSA account for services covered by Medicare or do I let Medicare I have exhausted that portions of funds and start using my regular Medicare and keep using the non MSA funds to pay for things like my co pays, medical issues Medicare doesn't cover?

Thank you in advance for any assistance you can give me.

Loki
 
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#2
it sounds like you are self-administering.
from the self-administering toolkit CMS wants the MSA funds separate from your non-MSA funds. whether you put both checks in a separate account or just cash the second check is your choice as medicare does not specify how you handle non-MSA funds.
"You must deposit your WCMSA money from the settlement in its own account, separate from any other accounts you may have. You will use the funds from this account to pay your future medical treatment and prescription costs related to the WC injury. It must be an account that earns interest, and should be insured by the Federal Deposit Insurance Corporation (FDIC). We also recommend an account that does not charge fees when you have a low balance, and that you can write checks from easily"

https://www.cms.gov/Medicare/Coordinatio...on-2_6.pdf

more information on self-administering including links to the toolkit and how/where to get help is on the CMS website
https://www.cms.gov/Medicare/Coordinatio...ation.html.

the second check is for non-MSA and yours to use as you need and is not limited to any specific use. it's your choice to use your own funds to pay for Medicare covered services. if you do choose to pay medicare services directly, You might want to contact them about their reimbursement process.

I did not read all the references to see if CMS allows prescription funds to go for services.


I am not an expert in CMS rules; this is just my personal interpretation.
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#3
(08-01-2017, 02:20 PM)1171 Wrote: it sounds like you are self-administering.
from the self-administering toolkit CMS wants the MSA funds separate from your non-MSA funds. whether you put both checks in a separate account or just cash the second check is your choice as medicare does not specify how you handle non-MSA funds.
"You must deposit your WCMSA money from the settlement in its own account, separate from any other accounts you may have. You will use the funds from this account to pay your future medical treatment and prescription costs related to the WC injury. It must be an account that earns interest, and should be insured by the Federal Deposit Insurance Corporation (FDIC). We also recommend an account that does not charge fees when you have a low balance, and that you can write checks from easily"

https://www.cms.gov/Medicare/Coordinatio...on-2_6.pdf

more information on self-administering including links to the toolkit and how/where to get help is on the CMS website
https://www.cms.gov/Medicare/Coordinatio...ation.html.

the second check is for non-MSA and yours to use as you need and is not limited to any specific use. it's your choice to use your own funds to pay for Medicare covered services. if you do choose to pay medicare services directly, You might want to contact them about their reimbursement process.

I did not read all the references to see if CMS allows prescription funds to go for services.


I am not an expert in CMS rules; this is just my personal interpretation.
 
Reply
#4
Thank you very much for your quick Remy attorney did a very good job of jumping through their hoops to appeal those denials.ply. I did deposit the WCMSA in a new account, in a bank close to where I live, but have never used before.
These links to MSA and their toolkits is extremely useful, as I know how important it is I follow all the rules "to a t". Even though the main document was 133 pages, I printed it out so that it is easier to read. I think it will make getting treatment much simpler and I won't have to wait months while the Ins. Co denies services. I then get to watch my attorney jump through all the hoops just to get the treatment approved months later.

The bank manager set up a Money Market Account for the MSA funds. I can write up to 3 checks a month for free and earn a small amount of interest. I figure this is all the checks I will need in a month: A Dr.'s visit, trip to pharmacy and a trip to the Dr.s office for a procedure on my neck.

The Bank Manager got a funny look on her face when I told her I wouldn't need the money from the 2nd check for a couple of years! She advised me to withdraw a small amount every 6-7 months so that the account doesn't go dormant..

Thanks Again for your reply

Loki
 
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#5
yes settling out your med can simplify everything.
you are welcome glad it helped.
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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