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If a medicare set aside is set up after a personal injury settlement, can the Plaintiff withdrawl that money for non-Medicare?

Chicago, IL |

If a medicare set aside is set up after a personal injury settlement, how long is that money set aside for future medical expenses related to the injury? What is the procedure for the Plaintiff to use that money?

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Attorney answers 4


A Plaintiff may never use the medicare set-aside funds for anything other than payment of future medical expenses related to the injury.

If you are managing your own medicare set aside account, you must follow specific accounting rules. Generally, you must keep records of expenditures from the account, which include: dates of service, provider, diagnoses, services received, the total bill paid and the date of payment. Additionally, you are required to submit an annual accounting to CMS which contains, among other information, all of the foregoing information. If the funds are found to be depleted without appropriate accounting, or if the funds are used for items other than the intended purpose, medicare may suspend your medical benefits or seek other action.

Ultimately, when the beneficiary passes, the funds will be set-aside for 180 days to pay off any remaining bills. Any remaining funds will then be disbursed to the estate.




It is very unusual to have this in a personal injury case, not as much in workers' compensation. Either way, the other attorney who answered is correct--an MSA is to be used for nothing but future medical expenses related to that injury.

I strongly suggest you do not manage your own fund but if you do, keep very detailed records of this money, keep it in a separate interest bearing account and, if you do use it for medical expenses, keep records and submit them to Medicare annually.

I wish you luck.
Stephen L. Hoffman
Law Office of Stephen L. Hoffman LLC
Chicago, IL

This answer posted on Avvo is for informational and educational purposes only. There is no attorney-client relationship created or formed and you should not rely on this as legal advice. The suggestion is made that if you wish to protect your rights, you consult with an attorney immediately.


Clients frequently ask me if they can utilize their Medicare-set-Aside(MSA) funds for non-Medicare expenses. My answer is "no...absolutely not". The MSA will be set-up until funds are exhausted. One thing to keep in mind, however, is that the thresholds and requirements to fund an MSA can be triggered before you are enrolled in Medicare. Therefore, you could have the MSA funds distributed to you before you are a Medicare beneficiary. Pursuant to the policies of the Center for Medicare Services (CMS), a petitioner/plaintiff cannot begin to use his MSA funds until entitled to Medicare. So, make sure you are a Medicare beneficiary before you start withdrawing from your account to pay for medical treatment.

In terms of the procedure, please note the following:

Record Keeping

· As Administrator of the account, you will be responsible for keeping accurate records of payments made from the account. These records may be requested by CMS' lead Medicare contractor as proof of appropriate payments from the MSA account.

· You may use the MSA account to pay for the following costs that are directly related to the account:

Photocopy charges

Mailing fees/postage

Any banking fees related to the account

· Annually, you must sign and forward a copy of a form--that can be downloaded from CMSs website-- providing self-attestation that payment from the MSA account was made appropriately for work-related/accident injuries that would otherwise be reimbursable by Medicare. The annual accounting shall be submitted no later than 30 days after the end of each year (beginning with one year from the establishment of the MSA account). Annual self-attestation should continue through depletion of the MSA account to the CMS lead Medicare contractor listed on the first page of this instruction.

I hope this helps


This answer is not a substitute for professional legal advice and does not create an attorney-client relationship, nor is it a solicitation to offer legal advice. If you ignore this warning and convey confidential information in a private message or comment, there is no duty to keep that information confidential or forego representation adverse to your interests. Seek the advice of a licensed attorney in the appropriate jurisdiction before taking any action that may affect your rights. If you believe you have a claim or case against someone, consult an attorney immediately, otherwise there is a risk that the time allotted to bring your claim or case may expire.

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