Medicare After Settlement

Medicare Set Aside

Your client could lose Medicare benefits if their settlement is meant to pay for injury-related expenses. The experts at Milestone can consult with your client to ensure they do not become disqualified from the program.

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What is a Medicare set aside?

When a person has certain insurance coverage or compensation – such as a personal injury settlement or workers compensation claim – those sources are responsible for covering their medical expenses first. After settlement, a Medicare set aside helps plaintiffs to properly consider Medicare’s rules as a secondary payer.

Complying with Medicare

Medicare is a secondary payer, which means when an injured person has certain types of insurance coverage or compensation, such as a settlement, other parties are legally responsible for paying first for medical expenses related to the injury before Medicare pays.

Primary payers might include:

  • Workers’ compensation
  • Settlement from a personal injury lawsuit
  • Liability insurance
  • Group health plan insurance
  • No-fault insurance

If those primary payers do not cover the full cost of services, Medicare may then become responsible for the balance of payment. Beneficiaries risk a denial of coverage for future medical expenses if they do not comply with Medicare’s rules. A Medicare set aside is one way to avoid compromising their coverage.

Consult with Milestone before settlement to determine whether a Medicare set aside is advisable for your client. 

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