Workers’ Compensation Medicare Set Aside Arrangements

A Workers’ Compensation Medicare Set-Aside (WCMSA) allocates a portion of the Workers’ Compensation (WC) settlement for all future work-injury-related medical expenses that are covered and otherwise reimbursable by Medicare.

The goal of establishing a WCMSA is to estimate, as accurately as possible, the total cost that will be incurred for all medical expenses otherwise reimbursable by Medicare for work-related conditions during the course of the beneficiary’s life, and to set aside sufficient funds from the settlement, judgment, or award to cover that cost. WCMSAs may be funded by a lump sum or may be structured, with a fixed amount of funds paid each year for a fixed number of years, often using an annuity.

Information for Health Care Providers regarding WCMSAs

Health care providers should bill an employee with a WCMSA based on the Maine Workers’ Compensation Medical Fee Schedule directly using the billing procedures outlined in Board Rules Chapter 5 and expect payment based on the Maine Workers’ Compensation Medical Fee Schedule.

If you mistakenly bill Medicare or other insurer for WC-claim-related treatment, you are responsible for refunding any payments received for that treatment.