What is Considered a Class I and Class II Beneficiary for a Medicare Set Aside?

There are many reasons why personal injury law firms outsource Medicare Set Aside services (MSA) to a professional that specializes in this specific area of settlements. The main reason trial attorneys seek assistance with MSAs is that the rules are extremely complicated. At Synergy Settlement Services, our team of experienced consultants can focus on the future medical cost projections of the settlement and ensure you are in compliance with all rules and regulations related to MSAs. This way you can remain focused on the important legal aspects of your case.

In this brief article, a settlement professional will discuss the qualifications for Class I beneficiaries and Class II beneficiaries for MSAs. Remember, for any of your law firm’s settlement needs, an experienced consultant is here to assist you.

What is Considered a Class I Beneficiary?  

When the future medical expenses are going to be secured through an MSA, the claimant must meet one of the following requirements to be considered a Class I beneficiary:

  • The claimant is 65 years of age or older
  • For at least two years (24 months) or longer, the claimant has been utilizing Social Security Disability (SSDI)
  • The claimant suffers from End Stage Renal Disease (ESRD)

If the settlement is valued at a total of $25,000 or greater, the MSA amount should be submitted to Medicare for their review and approval. This process ensures that Medicare’s interests are protected.

What is Considered a Class II Beneficiary?   

In order to be considered a Class II beneficiary, the claimant’s settlement total must be greater than $250,000 with a “reasonable expectation” of Medicare enrollment within a period of 30 months. In order to qualify as a Class II beneficiary, the claimant must meet one of the following requirements:

  • The claimant is 62 years and 6 months of age and will be eligible for Medicare within the next 30 months
  • Although the claimant is not eligible for Medicare, they are on SSDI  
  • The claimant has applied for SSDI or is appealing a denied SSDI ruling
  • The claimant suffers from ESRD, but does not qualify for Medicare yet

From structured settlements to special needs trusts to ensuring that settlement funds are appropriately managed and in compliance with the law, the settlement professionals at Synergy Settlement Services assist attorneys every step of the way with their settlement needs.

For more information about identifying a medicare set aside for personal injury cases or to schedule a consultation, please submit our contact request form.

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.


"Coincidentally, on the day of a recent Synergy Seminar on Medicare & ERISA lien resolution I received a letter on an ERISA lien. This letter followed much back and forth between myself and the recovery vendor for BCBS. Despite my efforts they were adamant there would be no (zero)(zilch)(nada) reduction and provided case law to support their position. I tried Synergy’s Lien Resolution Services since I had just heard their Director of Lien Resolution speak. Synergy got them to reduce their claim by a third in less than ten (10) days. The result was quick and the fee very reasonable. If you have a tough ERISA lien and your typical efforts don’t work, give Synergy a try."

Michael S. Smith, Esq.
Lesser, Lesser, Landy & Smith, PLLC

Synergy’s team makes it easy to deal with all of the issues we hate at the end of the case. Dealing with Medicare, ERISA liens, keeping eligibility intact for Medicaid and complicated planning for the client’s recovery. The experts we work with regularly at Synergy do a great job of making sure I am protected as are my clients.

J. Clancey Bounds
Bounds Law Group

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