Top 10 Workers’ Compensation Medicare Set-aside Arrangement (WCMSA) Questions

Top 10 Workers’ Compensation Medicare Set-aside Arrangement (WCMSA) Questions


[Intro music playing] Why did I get a Worker’s Compensation Medicare Set-Aside Arrangement letter from CMS? Your Workers Compensation insurance company submitted A WCMSA proposal to CMS, federal agency responsible for Medicare. CMS reviewed the proposal to determine If it is adequate to protect Medicare’s financial interests. What is a Worker’s Compensation Medicare Set-Aside Arragement? A WCMSA is a financial arrangement where CMS agrees to have Medicare pay for treatments and Medications related to your settled workers compensation injury. After you can show that you spent the CMS approved amount you set aside for your worker’s compensation settlement to pay for future medical expenses. Is Medicare telling me to settle my Worker’s Compensation Claim? No, the settlement is totally between you and your Workers Compensation Insurance. CMS is trying to make sure that you receive enough money from the settlement to cover future medical treatments and drugs that you will likely need So Medicare does not end up paying for anything that your Worker’s Compensation insurance should pay for. What is covered by the Worker’s Compensation Medicare Set-Aside Arrangement? You can only use the WCMSA funds for expenses related to the work injury. Things that Medicare would otherwise cover, things like doctor’s visits and medication. What if I want to use my settlement for things that are not covered by Medicare? If you think you want to be compensated for things that Medicare does not cover, Things like acupuncture or a gym membership You may want to negotiate a separate allotment for things like that before you settle the case with the workers compensation insurance. How do I use the Worker’s Compensation Medicare Set-Aside Arrangement funds? The WCMSA portion of the settlement goes into a bank account in your name separate from your other accounts. You pay your doctors and pharmacies directly with this account. Will Medicare send me a check? CMS and Medicare do not issue any monies. You need to contact your attorney or the workers compensation insurance carrier to complete the settlement for your work related injury. The funds come from the insurance company, not Medicare. What if I run out of money? As soon as your account is depleted, you need to send CMS an attestation letter stating that the account is exhausted. Send this attestation letter to the Benefits Coordination Recovery Center: BCRC NGHP, P.O. Box 138832, Oklahoma City, OK 73113 Medicare will start paying for future treatments related to your work injury if it can verify that the WCMSA money has been spent appropriately. If it is a structured MSA, Medicare coverage will remain until your funds are replenished. What happens to the Medicare Set-Aside Arrangement if I pass away before the money is used up? If there are remaining funds in the WCMSA account, some settlements allow your estate to retain the funds. While others request the funds to be returned to the insurance carrier. This is something you need to negotiate with the workers compensation insurance before the final settlement occurs. How does the annual attestation work? Every year on the anniversary of your settlement date, you need to fill out the annual attestation form and mail it to the Benefits Coordination Recovery Center BCRC NGHP, P.O. Box 138832, Oklahoma City, OK 73113

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