What is a Medicare Set Aside, and How Could it Apply to My Louisiana Automobile Accident?

What is a Medicare Set Aside, and How Could it Apply to My Louisiana Automobile Accident?
October 5, 2013 Gary

Many individuals that receive injuries in automobile and other accidents will have completed their medical treatment by the time they reach a settlement of their claim for damages. However, many people who receive more serious injuries may conclude their injury case but still need treatment in the future, possibly for the remainder of the lives. For example, many people with low back or neck injuries receive epidural steroid injections one of more times per year to control pain and hopefully improve their condition. The treating physician may warn the patient that these injections will be needed periodically for many years into the future or, a patient may undergo a surgery at one level of the spine, and at the conclusion of the case the surgeon may tell the patient that eventually another level of the spine will deteriorate enough that it will also require surgery. The cost of these future treatments are generally referred to as “future medical expenses.”

If a person injured in an automobile or trucking accident, or any other kind of accident, is a Medicare beneficiary, the federal laws provide that future medical expenses from an accident cannot be transferred to Medicare, but should instead be paid by the insurer of the negligent person causing the injuries. This requirement applies not only to current Medicare beneficiaries, but to anyone who might reasonably become Medicare-eligible within thirty months of the time of the settlement. Thus, a person who is 64 years of age at the time of settlement must consider whether further treatment for his or her injuries will be needed after the date on which the patient receives Medicare coverage. Similarly, a younger person who, perhaps because of multiple medical conditions, has or intends to apply for Social Security Disability insurance benefits, which would then allow the person to become Medicare eligible, must consider Medicare at the time of settlement.

A Medicare Set Aside is basically a fund of money which must be separated from the total settlement amount and used to pay any medical expenses a Medicare beneficiary incurs as a result of the accident, after the settlement. The beneficiary must be prepared to account to Medicare and show Medicare where the money went. The biggest difficulty in creating a Medicare Set Aside is correctly predicting the amount of medical expenses which might be incurred in the future as the result of an accident. Doctors can never be certain what treatment will be needed, or how often, and how much the price for that treatment will increase in the future. For that reason, there are many companies with which attorneys frequently contract to assist them with Medicare Set Aside issues. Typically, all of a patient’s medical records are provided to the contractor, which has specialized nurses review them and prepare a proposal which is basically their opinion as to the amount of money that will be required for future medical treatment as a result of the accident. Unfortunately, there is presently no requirement that Medicare approve the amount being set aside (except in worker’s compensation cases), there are no clear laws or regulations to help determine the precise amount which should be set aside, and there is much uncertainty in the field regarding the entire area of Medicare Set Asides. If an amount that Medicare deems appropriate has been set aside, then Medicare will pay medical bills in excess of that amount, if it turns out that your medical expenses were higher than anticipated. This is a very young area of the law, and the applicable rules change frequently.

At Koederitz Law Firm we have worked on many cases which have required Medicare Set Aside funds, and we have relationships with both attorneys who specialize in that area of law and contractors who review medical records and render opinions for Medicare Set Asides. If you have been involved in an accident, and you may need treatment for years into the future, it is important for you to consult with an experienced attorney. At Koederitz Law Firm, we are happy to assist you with this and many other issues that will arise after the occurrence of a severe injury as the result of an accident. Please call us today at Koederitz Law Firm, (225) 295-9494, for a free consultation regarding your Louisiana automobile accident.