- What it is:
An MSA is part of a workers’ compensation settlement set aside to pay for future medical care related to your work injury. - Why it matters:
Medicare will not pay for injury-related treatment that should be covered by workers’ compensation unless an MSA is properly set up and used. - Do I need one?
Not every case requires an MSA. It depends on whether you receive Medicare (or will soon), the size of the settlement, and whether future medical care is expected. - How the amount is decided:
A medical review estimates the cost of future treatment related to your work injury. That estimate becomes the proposed MSA amount. - Does Medicare have to approve it?
Sometimes, but not always. Approval can provide added protection but is not required in every case. - How the money is handled:
The MSA can be paid in a lump sum or over time. You may manage it yourself or use a professional administrator. - What happens if the rules aren’t followed?
Medicare may refuse to pay for future injury-related medical care.
Putnam Law helps determine if an MSA is needed, coordinates the process, and guides you so your settlement and future Medicare benefits are protected.
Self-Administered Medicare Set-Aside (MSA) Checklist
If you are managing your own MSA, follow these steps to stay compliant and protect your Medicare benefits:
- Before You Spend Any MSA Funds
- ☐ Open a separate, interest-bearing bank account for the MSA only
☐ Deposit the full MSA amount (or initial structured payment)
☐ Keep a copy of your settlement agreement and MSA allocation
☐ Review which medical services and prescriptions are allowed under the MSA - Using Your MSA Funds
- ☐ Use MSA money only for medical treatment related to your work injury
☐ Make sure treatment is Medicare-covered
☐ Pay medical providers directly from the MSA account
☐ Use the MSA account to pay for injury-related prescriptions only
☐ Do not use MSA funds for co-pays, non-covered care, or unrelated treatment - Record-Keeping (Very Important)
- ☐ Keep all bills, receipts, and Explanation of Benefits (EOBs)
☐ Track every deposit and payment from the MSA account
☐ Keep a running balance of the account
☐ Save records for the life of the MSA - Annual Reporting
- ☐ Submit an annual accounting to Medicare (if required)
☐ Include starting balance, deposits, payments, and ending balance
☐ Confirm whether professional help is needed for reporting - When the MSA Runs Out
- ☐ Notify Medicare when MSA funds are properly exhausted
☐ Once confirmed, Medicare may begin paying for injury-related care - Get Help When Needed
- ☐ Contact your attorney if you are unsure whether an expense is allowed
☐ Consider a professional MSA administrator if the process becomes overwhelming - Reminder:
Improper use of MSA funds can result in Medicare refusing to pay for future treatment related to your injury.
Putnam Law is available to answer questions and help ensure your self-administered MSA stays compliant and your benefits are protected.
