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Medicare Set-Aside

Summit Structured Settlements
755 S.E. Frontier Suite 101
Waukee, Iowa 50263

Voice: 515.987.6888
Fax: 515.987.6999
Toll Free: 866.267.1177

Medicare Set-Aside

When a person is a Medicare eligible, part of any injury settlement received for future medical treatment must be “set-aside” and used to pay for medical expenses that would normally be paid for by Medicare, if it were not for the injury.

42 USC §1395y (b) (2) - If a settlement contains an amount for future medical expenses, the settlement is considered the primary coverage for payment. The regulations provide that if a reasonable portion of the settlement proceeds are allocated, or set-aside, for expenses otherwise covered by Medicare, only the allocated funds must be properly spent down; not the entire amount of the settlement - 42 CFR §411.46-§411.47.

Federal law precludes Medicare payments for any item or service if payment has been made or can reasonably be expected to be made by a responsible third party (i.e. Workers Compensation or Liability or Health Insurance Company.

A Medicare Set-Aside estimate is prepared and sent to The Centers for Medicare and Medicaid Services for their Determination of adequacy. Sounds simple, but in reality can be very difficult in the throws of litigation.

A proper Medicare Set-Aside will co-ordinate and preserve your Medicare benefits.
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