How to Calculate Medicare Set-Aside

In 1985, Congress enacted the Medicare Secondary Payer statute as a way to reduce costs for the federal government. The statute established that Medicare will not cover costs a responsible body -- such as a worker's compensation plan -- can cover on its own for the claimant. According to the Trial Lawyer Resource Center, this means a claimant will have to calculate both the amount needed for hisr treatment and the amount the responsible body will cover before he can determine how much he should receive from Medicare. This is especially important for the payment the claimant would like for future costs, also known as the set-aside amount.

Instructions

• 1

  Write down the life expectancy of the claimant. According to the Ramos Law Firm website, this figure can vary considerably over time. The life expectancy tells Medicare officials how many years of recurring treatments the claimant will need to pay for.

• 2

  Determine any factors that may inhibit the normal progression of the client's recovery. These include issues like climate, separate and underlying medical conditions, and mental health concerns. Depending on the factor, this may warrant a larger set-aside.

• 3

  Describe the medical treatment currently prescribed by the claimant's authorized physician. Medicare will pay for those treatments not covered by the responsible body.

• 4

  Determine the medication regimen prescribed by the authorized physician. As with future treatments, Medicare will pay for medications not covered by the responsible body.

• 5

  Identify the evolving applications of care as defined by Medicare. This refers to costs that may increase or decrease over time. For example, a claimant confined to a wheelchair will require less money for physical therapy if her doctor says she will be able to walk again in the foreseeable future.

• 6

  Determine what the responsible body covers. A claimant should consult either his employer or his health insurer to determine what kinds of injuries and treatments are covered under its plan.

• 7

  Determine which of these treatments the claimant will require in the future. Medicare will subtract this amount from the total set-aside.

• 8

  Write down all of these costs in a Workers Compensation Medicare Set-Aside Arrangement (WCMSA). You can obtain this form from the U.S. Department of Health and Human Services. Send this form to the Medicare office, and it'll respond with an estimate of your set-aside.