If you get hurt on the job in Missouri, you are entitled to workers’ compensation. If your case settles, you will get a check for a lump sum that covers your future disability payments and your future medical care.
When you reach retirement age, though, your healthcare can be covered by Medicare. This presents a problem: You would have received money to cover the ongoing medical care associated with your work injury, but now you also have a source of coverage for that same medical care.
The Medicare set-aside process is the law’s way of preventing you from receiving a windfall in this situation.
Medicare Set-Aside is Legally Required Under Federal Law
Lawmakers in Washington, D.C., realized this potential issue and included the provision 42 U.S.C § 1395y(b) in the statute that created the Medicare system.
This statute forbids Medicare from being the primary payer for costs associated with a workplace injury that led to a workers’ compensation settlement. It requires state workers’ compensation systems to consider the interests of the federal Medicare program when settling cases.
Those workers’ compensation systems do this by removing and setting aside a portion of the money from your settlement to cover the expenses that Medicare would likely have to pay for.
How the Set-Aside is Calculated and Used
When you recover from your work injury, you may reach a level of maximum medical improvement (MMI). This is the point at which further medical care will not improve your condition. It is also the point where the treating physician can see what medical care you will need in the future to treat your injuries.
The workers’ compensation insurance company will investigate to determine the costs of that future care. Key factors in this determination will be the extent of the care necessary, its price, and your life expectancy, as that will dictate how long you will need the care.
The resulting amount will be taken out of your workers’ compensation settlement check and set aside in a special bank account. Whenever you get medical care for the workplace injury, Medicare will pay for the treatment and you will reimburse Medicare from the set-aside account.
Importantly, there is nothing stopping you from using the set-aside account for other, non-medical, purposes. However, Medicare can refuse to cover medical treatment if there are not enough funds in the account.
Workers’ Compensation Lawyers at the Smith Law Office Serve Western Missouri
The Medicare set-aside process is a confusing one. It can also be frustrating to see your settlement moved off into a different account for a specific purpose.
The personal injury and workers’ compensation lawyers at the Smith Law Office strive to legally represent hurt workers through the entire compensation process. Contact us online or call our law office at (816) 875-9373 for help in St. Joseph, Kansas City, Springfield, or the rest of western Missouri.