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WHEN SHOULD A MEDICARE SET-ASIDE ARRANGEMENT BE CONSIDERED?

by Thomas D. Begley, Jr., CELA

In settling of a personal injury case, commonly called a third party liability case (TPL), a Medicare Set-Aside Arrangement (MSA) should frequently be considered. Many Lawyers and Structured Settlement Brokers believe that if the client is not currently receiving Medicare, an MSA need not be considered. However, the Regulations require consideration of an MSA even if there is a “reasonable expectation” of receiving Medicare within thirty months. Individuals receiving SSDI or RRD are eligible for Medicare within twenty-four months of their Determination of Disability. Therefore, an MSA should be considered if:

  • Plaintiff is receiving Medicare
  • Plaintiff is receiving Social Security Disability Insurance (SSDI)
  • Plaintiff is receiving Railroad Retirement Disability (RRD)
  • Plaintiff has applied for SSDI
  • Plaintiff has applied for RRD
  • Plaintiff is appealing an SSDI denial
  • Plaintiff is appealing an RRD denial
  • Plaintiff suffers from End Stage Renal Disease (ESRD)
  • Plaintiff suffers from ALS
  • Plaintiff requires ongoing treatment related to the injury that is not covered by other insurance

Plaintiffs’ attorneys might want to consider putting this checklist inside each file to determine whether or not an MSA is appropriate.

 

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