WCMSA – Workers Compensation Medicare Set-Aside

If you want to avoid delaying a client’s settlement and noncompliance with federal law, let Synergy Settlement Solutions assist you with proper settlement planning and preserving your client’s benefits through a workers compensation medicare set aside (WCMSA) arrangement.

Medicare Secondary Payer (MSP)

If you are representing a client in a workers’ compensation settlement who is also a Medicare recipient, both you and your client are responsible for abiding by Medicare Secondary Payer (MSP) laws. In a workers’ compensation settlement, Medicare is considered a secondary payer. This means that by law, a Medicare beneficiary is required to apply for workers’ compensation benefits to pay for work-related injury medical expenses before Medicare will pay for any treatments.

What is Workers’ Compensation Medicare Set-Aside Arrangement?

Whenever you are handling a case that involves Medicare and the settlement of a case involving future medical expenses, you must ensure that the interests of Medicare are protected in the process. According to MSP laws, a workers compensation MSA is sufficient solution for doing so.

The purpose of a WCMSA is to preserve future Medicare benefits. It is an agreement where a portion of a client’s workers’ compensation settlement is allocated to pay for future medical expenses related to the client’s case. After the settlement funds have been depleted, Medicare will begin paying (with respect to payment stipulations) for the client’s injury-related treatments. It’s important to note that the amount of the WCMSA is determined on a case-by-case basis and reviewed by the Centers for Medicare and Medicaid Services (CMS).

Is a CMS Review Required?

A workers compensation MSA proposal does not have to be submitted for review to the CMS; however, it is highly recommended. If you choose to submit to CMS for review, the claimant must either be a Medicare beneficiary with a settlement greater than $25,000; or have a reasonable expectation of Medicare enrollment within 30 months of their settlement with a total settlement that exceeds $250,000. The CMS has a set of criteria to determine if the amount allocated for future medical expenses is reasonable.

Why Partner With Synergy Settlement Solutions?

As an attorney, you should know that there are ethical and legal obligations connected to protecting the interests of Medicare in a workers’ compensation case. Failing to do so can lead to legal actions against you. No longer do you have to go through many companies to meet MSP compliance and secure a WCMSA, our highly skilled consultants provide a range of settlement service solutions to make the entire process easy for you.

For more information or to schedule a consultation, please submit our contact request form or call (877) 242-0022.

Disclaimer: The information contained in this article is for general educational information only. This information does not constitute legal advice, is not intended to constitute legal advice, nor should it be relied upon as legal advice for your specific factual pattern or situation.


I wanted to pass my highest recommendation to Synergy who we routinely get involved in cases when Medicare issues come up, especially when dealing with Medicare Set Asides. Synergy went beyond the call of duty in a recent case that was settled and dealt one-on-one with our clients and their family. They spent time on the phone with them to be sure they got all their questions answered and did a fantastic job dealing with Medicare.

J. Daniel Clark
Clark Martino, P.A.

"I recently engaged Synergy to assist with a complicated PTD settlement involving a substantial Medicare Set Aside. The claimant’s wife has been providing full time attendant care which is not Medicare covered. The Synergy nurse was able to do a full analysis of non-Medicare covered expenses which far exceeded the value of the MSA analysis performed by the carrier’s contracted MSA provider. The non- Medicare figures became the main focus of the settlement negotiations and more than doubled the value of the case. Although I could estimate the attendant care figures, the nurse added in other items that I would not have routinely considered. I also asked Synergy to evaluate the EC’s MSA as well as their prescription review. Synergy offered insight about the prescription donut hole which I did not have a clear understanding about. Again, their insight and information added a great deal of value to the overall settlement. Not only did I learn from Synergy but was able to educate my clients in the process. These are very complex and complicated areas; I will use Synergy again and again!"

Rosemary Eure
Lancaster & Eure

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