Summit Structured Settlements
755 S.E. Frontier Suite 101
Waukee, Iowa 50263
Toll Free: 866.267.1177
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
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