There was a point in time when you could settle an injury claim (e.g., automobile accident, slip and fall), and all you needed to worry about was your lawyer’s share of the settlement fund. That’s changed over the years, and among other things, you now need to consider whether a Medicare Set-Aside is going to be required to reimburse the government for your future medical expenses relating to your injury.
Medicare Set-Aside law is complicated. It is designed to set up a trust-like arrangement to hold some of the settlement dollars for future medical expenses related to your injury, and is in addition to any rights Medicare may have for reimbursement for injury-related medical expenses that Medicare paid for prior to settlement. Currently the government is interested in setting up a Medicare Set-Aside in two instances:
- You are a Medicare recipient (you are over 65 or receiving Medicare based on a disability) and settling a personal injury claim for more than $25,000; or
- If your settlement is for more than $250,000 and you expect to be a Medicare recipient within 30 months of the settlement.
Medical Set-Aside used to apply only to workers’ compensation claims, but that is no longer the case. So, if you fall within the scope of the requirements, and your injuries are such that future medical expenses are anticipated, the government will continue to be a “secondary” payer and will want to ensure that settlement dollars (from the “primary” payer who caused your injury) are allocated to future medical expenses before Medicare dollars kick in and the government is paying the tab.