Medicare and workers’ compensation – How the Medicare set-aside process works to ensure medical care for injured workers

Carolyn Cahn, RN, PHN, COHN, MHA, Centers for Medicare & Medicaid Services, US Department of Health & Human Services, 75 Hawthorne Street, Ste. 408, San Francisco, CA 94105-3901, 415744-3509, smilingcarolyn@hotmail.com

Medicare has been a secondary payer to Workers’ Compensation since the Medicare Program’s inception in 1965. If a Medicare beneficiary receives a Workers’ Compensation settlement or award, then Medicare must be notified. If an individual will become a Medicare beneficiary within 30 months of the date of a Workers’ Compensation settlement and the total settlement is $250,000 or more, then Medicare must be notified.

Medicare’s regulation 42 CFR 411.46 requires that all Workers’ Compensation settlements must adequately consider Medicare's interests. This session will address how Medicare reviews a case once it is submitted for review, and will provide valuable information for anyone working with injured workers who are currently on social security as well as those on, or applying for, permanent disability. The program will include an initial explanation of why Medicare has the right to review workers’ compensation awards and the dangers posed to all parties if the policy is not adhered to. Every professional working with injured workers should advocate this Medicare Set-Aside (MSA) process for their clientele who meet the criteria.

Learning Objectives:

At the end of the session the participant will be able to do the following

1. Identify how their the Medicare Set-Aside (MSA) process can be incorporated into their professional role.
2. Identify persons covered by the MSA process.
3. Explain the relationship between workers’ compensation and the Medicare program.
4. Explain the relationship between disability and the MSA program.

Keywords: Medicare, Workers' Compensation

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation

Disabilities and The Environment: Overcoming Barriers

The 132nd Annual Meeting (November 6-10, 2004) of APHA