Eighth in a series of blog posts dedicated to helping clients decide when a structured settlement should be considered.

Today’s Installment: Medicare Secondary Payer Act

August 13, 2019 – If there’s one area of claims resolution where structured settlements attain near universal acceptance, it’s when they are used in conjunction with settling a claim impacted by the Medicare Secondary Payer Act (MSP).

In 1980, when Congress passed the Medicare Secondary Payer Act, U.S.C. § 1395y(b), the goal was a simple and noble one: Protect the Medicare trust fund by prohibiting payment for medical services which have “been made or can reasonably be expected to be made” by a primary payer.

For about 20 years, few gave much thought to the reality that workers’ compensation and liability claims were being settled every day without even considering Medicare’s interests, creating de facto lawbreakers since many settlements involved such payments.

Even when liens for past medical costs absorbed by Medicare began to be taken seriously, future care stemming from the compensable injury and upon which the settlement value was determined, was ignored resulting in many injured workers or plaintiffs “double dipping.”

Medicare Set-Asides

To avoid shifting responsibility for future injury-related care to the secondary payer, Medicare, a cottage industry emerged offering a solution: Medicare Set-Aside (MSA) arrangements.

Companies specializing in evaluating an individual’s future accident-related medical care review the case to recommend an allocation which should be attributed to protecting Medicare’s interests. The settling parties, then, should “set aside” these funds from any settlement to ensure all are meeting their compliance requirements under the law.

Commonplace in most workers’ compensation claims, the usage of MSAs in liability settlements has grown in recent years.

Sometimes the parties opt to secure approval from the Centers for Medicare & Medicaid Services (CMS) before concluding their settlements while some companies will guarantee their evaluations and agree to hold the parties harmless if CMS refuses to honor their evaluation.

Structured Settlements Save Money

When MSAs are procured, the settling parties can choose to satisfy their MSP obligation by paying the recommended single lump sum or by providing two years’ worth of “seed money” followed by a series of annual payments for a specified period of time.

While the single lump sum option is typically the better choice on smaller (under $25,000) MSAs, substantial savings can be realized by opting for the annuitized option as the MSA increases in value.

Quantifiable savings: On the last dozen cases our firm has quoted, we’ve been able to demonstrate an average 20.37% savings on the cost of funding the MSA.

Whether the savings realized by structuring an MSA is used to reduce the overall cost of the settlement or to increase the net, non-MSA recovery to the plaintiff/claimant, there’s no denying the value of this excellent claims resolution tool.

And as MSAs become increasingly prevalent, expect claim settlement cost efficiency and fairness to strengthen.

For further reading: “A Good Fit”