Injuries can be a real pain, both physically and financially. But timely compensation can help cover your medical expenses and lessen the hit to your wallet.
If you sustained an injury while at work and now qualify for Medicare, there are different rules and regulations to get medical coverage. Your medical expenses could include anything from doctor visits, follow-ups and tests to prescription drugs.
That's where a Medicare Set-Aside comes into play. As the name suggests, it’s a designated sum set aside to cover medical expenses related to an injury.
Let's look at what a Medicare Set-Aside
If you suffer an injury or illness at work, your employer may provide financial compensation — known as worker’s compensation — to help pay your medical expenses and lost wages.
A Medicare Set-Aside (MSA), also known as a Worker's Compensation Medicare Set-Aside ( WCMSA
The MSA ensures that Medicare's interests are protected and that Medicare does not pay for medical expenses that should be the responsibility of the workers' compensation carrier or liability insurer.
MSAs are used in case of severe or long-term injuries or illnesses and can either be a lump sum or a structured settlement.
A Medicare Set-Aside account, or WCMSA account, is a separate interest-bearing account where you allocate your worker's compensation fund for future medical expenses.
Interest from these funds must remain in the account and can only be used for medical expenses.
The funds from a settlement can be added to a WCMSA in one lump sum or through a structured settlement annuity that refills the account gradually over time.
Medicare Set-Aside (MSA) isn't mandatory. However, it's used to set aside money from a settlement to pay for future medical expenses related to your work injury or illness.
An MSA report, a document outlining injury-related expenses, can be made simpler by having a Medicare Set Aside (MSA) account in place. Since your MSA account funds are only used to cover your work-related injury expenses, it's easy to manage and report these expenses to Medicare.
Medicare
You're a Medicare beneficiary getting a worker's compensation settlement of more than $25,000.
You're receiving a worker's compensation settlement and will be eligible for Medicare within the next 30 months with a total settlement amount of more than $250,000.
No.
Once you open a Medicare Set-Aside account, it can only be used to pay for medical expenses and prescription drugs related to the workers' compensation claim, i.e., those medical expenses resulting from the work injury. Medicare should cover these expenses otherwise.
Note that this applies even if you're not yet enrolled in Medicare.
If the funds in your Medicare Set-Aside (MSA) account are used up, Medicare will become the primary payer. Medicare will cover all the medical expenses related to your injury or illness, provided that you meet certain requirements.
Medicare will provide coverage only if:
You're a Medicare beneficiary
The MSA funds were used according to the Medicare guidelines
The MSA expenses were reported to Medicare
Medicare guidelines and regulations are complex, so it's a good idea to talk to a professional who can help you understand your policy benefits.
Getting professional help can assist with coordinating benefits, obtaining approvals, and monitoring funds to ensure compliance with Medicare regulations, heading off potential issues. This helps get your medical expenses covered after your MSA funds are depleted.
Once Medicare steps in, you'll be subject to the same co-pays, coinsurance, and deductibles as other Medicare beneficiaries for treatments related to your injury.
At the end of each year, unused funds are carried over to the next year.
If your worker compensation is deposited annually, you can use it together with Set-Aside funds carried over from the previous year for your medical expenses.
In case of death, any unused funds in the Medicare Set-Aside account will be disbursed to a beneficiary(s) named in the settlement agreement after a waiting period of twelve months.
During this period, providers, physicians, and other suppliers can submit their bills to Medicare for reimbursement.
After the waiting period, the administrator will disburse any remaining funds to the designated beneficiaries.
Beneficiaries can include family, friends, or charitable organizations.
A Medicare Set-Aside or WCMSA is a dedicated fund from your worker's compensation settlement that covers medical expenses related to a work injury. This means your worker's compensation is the primary payer for all medical expenses related to your work injury until funds in your WCMSA are depleted. At this point, Medicare becomes the primary payer. Compliance with federal guidelines and regulations is mandatory to access Medicare benefits.
The Medicare Set-Aside rules and regulations can be confusing, but it's necessary to comply with them to get benefits.
Contact our advisors at Fair Square Medicare
Does Medicare Cover Cosmetic Surgery?
Nov 28, 2022
Medicare Guaranteed Issue Rights by State
Feb 10, 2023
Building the Future of Senior Healthcare
Aug 25, 2022
Does Medicare Cover Compounded Medications?
Apr 4, 2023
2025 Medicare Price Changes
Oct 30, 2023
Comparing All Medigap Plans | Chart Updated for 2025
Aug 1, 2022
Medicare Advantage MSA Plans
May 17, 2023
How Much Does Open Heart Surgery Cost with Medicare?
Jan 27, 2023
What is a Medicare Beneficiary Ombudsman?
Apr 11, 2023
What is the 8-Minute Rule on Medicare?
Dec 21, 2022
How Much Does Trelegy Cost with Medicare?
Jan 24, 2023
Does Medicare Cover Macular Degeneration?
Nov 30, 2022
Can Medicare Advantage Plans be Used Out of State?
Jun 12, 2023
Does Medicare Cover Jakafi?
Dec 12, 2022
Does Your Plan Include A Free Gym Membership?
Jul 12, 2023
14 Best Ways for Seniors to Stay Active in Seattle
Mar 10, 2023
13 Best Ways for Seniors to Stay Active in Phoenix
Mar 6, 2023
Does Medicare Cover SIBO Testing?
Dec 1, 2022
13 Best Ways for Seniors to Stay Active in Indianapolis
13 Best Ways for Seniors to Stay Active in Jacksonville
13 Best Ways for Seniors to Stay Active in Philadelphia
2024 Fair Square Client Retention and Satisfaction Report
2024 Fair Square NPS Report
Are Medicare Advantage Plans Bad?
Can I Change My Primary Care Provider with an Advantage Plan?
Can I Use Medicare Part D at Any Pharmacy?
Do All Hospitals Accept Medicare Advantage Plans?
Do I Need to Renew My Medicare?
Does Medicare Cover Air Purifiers?
Does Medicare Cover Breast Implant Removal?
Does Medicare Cover Cala Trio?
Does Medicare Cover Cartiva Implants?
Does Medicare Cover Cervical Disc Replacement?
Does Medicare Cover Cold Laser Therapy (CLT)?
Does Medicare cover Deviated Septum Surgery?
Does Medicare Cover Diabetic Eye Exams?
Does Medicare Cover Driving Evaluations?
Does Medicare Cover Exercise Physiology?
Does Medicare Cover Fosamax?
Does Medicare Cover Geri Chairs?
Does Medicare Cover Hearing Aids?
Does Medicare Cover Hepatitis C Treatment?
Does Medicare Cover Hoarding Cleanup?
Does Medicare Cover Hypnotherapy?
Does Medicare Cover Inqovi?
Does Medicare Cover Inspire for Sleep Apnea?
Does Medicare Cover Iovera Treatment?
Does Medicare Cover Light Therapy for Psoriasis?
Does Medicare Cover Linx Surgery?
Does Medicare Cover Lipoma Removal?
Does Medicare Cover LVAD Surgery?
Does Medicare Cover Oxybutynin?
Does Medicare Cover Ozempic?
Does Medicare Cover Penile Implant Surgery?
Does Medicare Cover PTNS?
Does Medicare Cover Robotic Surgery?
Does Medicare Cover TENS Units?
Does Medicare Cover the Urolift Procedure?
Does Medicare Cover Tymlos?
Does Medicare Cover Urodynamic Testing?
Does Medicare Cover Wart Removal?
Does Medicare Pay for Funeral Expenses?
Does Medicare Require a Referral for Audiology Exams?
Explaining IRMAA on Medicare
Explaining the Different Enrollment Periods for Medicare
How Can I Get a Replacement Medicare Card?
How Medicare Costs Can Pile Up
How Much Does a Medicare Coach Cost?
How Often Can I Change Medicare Plans?
How to Choose a Medigap Plan
How to Deduct Medicare Expenses from Your Taxes
Is Emsella Covered by Medicare?
Is Gainswave Covered by Medicare?
Is the Shingles Vaccine Covered by Medicare?
Medicare & Ozempic
Medicare 101
Medicare Advantage Plans for Disabled People Under 65
Medicare Deductibles Resetting in 2025
Medicare Supplement Plans for Low-Income Seniors
The Easiest Call You'll Ever Make
The Fair Square Bulletin: October 2023
What Does Medicare Cover for Stroke Patients?
What Happens to Unused Medicare Set-Aside Funds?
What Is a Medicare Supplement SELECT Plan?
What Is the Medicare Birthday Rule in Nevada?
What is the Medicare ICEP?
What To Do If Your Medicare Advantage Plan Is Discontinued
What to Do When Your Doctor Doesn't Take Medicare
When Can You Change Medicare Supplement Plans?
Why You Should Keep Your Medigap Plan
Get the Fair Square Bulletin
Medicare savings tips, helpful guides, and more.
Virgil Insurance Agency, LLC (DBA Fair Square Medicare) and www.fairsquaremedicare.com are privately owned and operated by Help Button Inc. Medicare supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. This is a solicitation of insurance. A licensed agent/producer may contact you. Medicare Supplement insurance is available to those age 65 and older enrolled in Medicare Parts A and B and, in some states, to those under age 65 eligible for Medicare due to disability or End-Stage Renal disease. Virgil Insurance Agency is a licensed and certified representative of Medicare Advantage HMO, HMO SNP, PPO, PPO SNP and PFFS organizations and stand-alone PDP prescription drug plans. Each of the organizations we represent has a Medicare contract. Enrollment in any plan depends on contract renewal. The plans we represent do not discriminate on the basis of race, color, national origin, age, disability, or sex. Plan availability varies by region and state. For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov. © 2025 Help Button Inc
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
MULTIPLAN_FairSquareMedicare_01062022_M