My settlement is final and I received a check for the Medicare Set-Aside (MSA) funds from my worker's compensation carrier. What do I do now?
The funds for your MSA must be deposited in a separate, interest-bearing account under your name.
If you currently enjoy professional administration of your MSA as an Opal customer, or plan to do so in the future, please call us at 1-866-858-7161 and our team of experienced specialists can help.
If you currently self-administer your MSA or plan to do so in the future, Onyx can provide the instructions, forms, and resources (including telephone support) that you need to stay in compliance. Learn more about Onyx, and contact us anytime.
What kind of an account should this be? Can I put part of the funds into a CD or other type of account?
There are no specific requirements for this. We suggest an interest-bearing checking account, so you have immediate and ongoing access to the funds for payment of covered medical services. Yes, you may retain excess funds in a CD or other accounts if desired.
Does the MSA account need a special name? What should I tell the bank when I set this up?
The MSA account does not need a special name. You just need to know that this separate account is only for use with injury-related services that would otherwise be paid by Medicare.
Can I add a spouse or other family member to the account that I set up for my Medicare Set-Aside?
How do I know what is payable from my MSA account?
The services and prescriptions specified in the approval letter you received from the Centers for Medicare and Medicaid Services (CMS) are covered, as are any other medical services that are directly related to your injury and would otherwise be covered by Medicare. You can request assistance regarding coverage from your providers, or call Medicare at 1-800-633-4227.
I have a copy of the CMS approval letter. Not everything that is related to my injury is listed on the letter. Do I call Medicare to confirm? Are services not listed in the letter payable from the MSA account?
The CMS approval letter is meant as assurance by Medicare that their interests are properly covered, if the account is funded according to the terms of the letter, for at least the services noted. If your medical providers agree that additional medical conditions are related to the original injury, then as long as medical services and prescriptions related to those conditions are otherwise Medicare allowable, they may be paid for from your MSA account.
My workers' comp carrier paid for transportation for my doctor appointments. Can I reimburse myself for mileage or pay for a taxi or other transportation for appointments from my MSA account?
No. Transportation is not an expense that is covered by Medicare and therefore not payable from an MSA account.
My settled claim included injuries to my eyes and I now need replacement eyeglasses. I believe this should be payable from my account as this is a medical expense and was paid for by the carrier. Is this true?
No. This is not a payable expense, because eyeglasses are not payable under Medicare guidelines. Even though glasses were paid for by your workers’ compensation carrier, funds were not included in your set-aside for replacement glasses because they are not a covered expense from an MSA account.
How do I know how much to pay my doctor or other provider?
If you are not utilizing professional administration or self-administration support services, you may contact your state’s division of workers’ compensation to obtain that state’s fee schedule or work with your provider’s billing office for fee schedule information. CMS requires that you make your best effort to pay for injury-related services at the rate that was used for the allocation and approved by CMS.
I have been referred to a specialist and my Primary Care Physician’s office is charging me for record copies. Is this payable from my MSA account?
Yes, CMS permits injury-related photocopying charges, mailing fees/postage, and any bank fees related to the account to be paid or reimbursed from your MSA account.
Can I withdraw any interest earned on my MSA account for personal use?
No. All interest earned on the account is to accrue in the account for payment of your allowable expenses. You may reimburse yourself for any taxes you pay on interest earned from the MSA account.
Do I mail the completed annual accounting/attestation form to Bridge Pointe?
No. The accounting/attestation form is to be mailed each year to the Medicare Secondary Payer Review Center (MSPRC). (An attestation is a signed statement: you are “attesting to” your appropriate use of the money.)
This is one of the services included with Opal.
What is the current address of the Medicare Secondary Payer Review Center (MSPRC)?
The current address is:
Attn: MSP-Medicare Set-Aside Reconciliation
PO Box 138832
Oklahoma City, OK 73113
When do I need to mail the annual accounting form and what do I need to include?
The accounting/attestation form is to be mailed once a year to the Medicare Secondary Payer Review Center (MSPRC), beginning no later than 30 days after the anniversary of your settlement. You are to provide a separate total for prescription drug expenses and all other medical expenses paid from the account as noted on the form.
This is one of the services included with Opal.
Will I receive a new annual accounting/attestation form in the mail every year?
No. If you self-administer your MSA, you should make a number of copies of the original form. The MSPRC does not mail out new forms annually.
Who notifies Medicare when the MSA account is out of money?
You do. If your MSA is funded with an annual annuity payment, your account may on occasion be “temporarily depleted”. As soon as you know this will occur, you are to send in a copy of the accounting/attestation form to the MSPRC with section 2 (Temporary Depletion) completed.
If the account is permanently out of money, you are to send in a copy of the accounting/attestation form to the MSPRC with section 3 (Permanent Depletion) completed.
These services are included with Opal.
What do I need to send to Medicare when the MSA account is out of money? And to which Medicare office do I send the documents?
Temporary or permanent depletion notices are to be sent to the MSPRC at the address above. These notices are the same forms used for the annual accounting, with the appropriate section filled in. You are to sign and date the accounting/attestation form, and have it witnessed by one other person, who will also sign and date. (The signatures do not need to be notarized). Mail the completed form only to the MSPRC. Do not mail any check copies or receipts unless requested by the MSPRC. Retain all check copies, receipts, and a copy of your completed accounting/attestation form for your records.
These services are included with Opal.
If my MSA account runs out of money, who will pay my medical bills?
If you self-administer your MSA and your account is temporarily or permanently out of funds, you are to notify your providers of any alternate insurance coverage that you may have. You will be responsible for any co-pays/out of pocket expenses during this period and may not reimburse yourself from the account funds when they are replenished.
Coordinating your various insurances (including Medicare) and notifying providers are services included with Opal.
I am not getting any more medical care for this injury. Can I close the set-aside account and take the funds for personal use?
No. The set-aside funds are to be kept in a separate account and to be available for covered injury-related care for your lifetime. (Previous CMS guidelines regarding early account closure were rescinded in the 8/25/08 memorandum.)
I have medical coverage under my spouse’s group health plan. Why do I need this MSA account?
MSA funds are meant to be primary to alternate coverage unless specifically addressed by an alternate insurance plan in your settlement. MSA funds that are not used in any given year are meant to roll over and accrue for future use as needed.
I am enrolled in Medicare. Can my doctors bill Medicare? Can I use my MSA account funds for co-pays for the doctor and for prescriptions?
No. Your MSA account is intended to be primary (pay first) to Medicare. The Medicare set-aside is meant to protect the Medicare Trust Fund, by ensuring that no injury-related bills are sent to Medicare as long as funds remain in the MSA account.
Medicare is always a secondary payer to liability insurance (including self-insurance), no-fault insurance, workers’ compensation benefits, and all settlement (or judgment) funds awarded for future medical care. That means Medicare is prohibited by law from paying for services until all such insurances and monies — including your MSA — are temporarily or permanently exhausted.
If I make an appointment for both injury-related services and non-injury-related services, do I pay for the appointment from the set-aside or do they bill Medicare? How do I know what to tell them?
It is up to you to determine at the time the appointment is made whether the main purpose for the appointment is for care for the covered injury or not. It is your responsibility to request to pay from your MSA account or have the services billed to Medicare accordingly.
What happens to the money in the MSA Account if I pass away before the account is depleted? Does the money go to my estate?
When you establish the MSA account at your bank, they should request beneficiary information from you as they would with any other bank account. If no beneficiary is named and there is no other name on the account, the funds would be payable to your estate or subject to state law.
What can happen if I use the funds for non-injury-related services or if I do not establish a Medicare Set-Aside account at all?
If any of the MSA funds are determined by Medicare to have been used inappropriately, Medicare will refuse to cover any injury-related services until they receive documentation that the funds have been restored to the account and used appropriately. If Medicare’s interests are not considered at all, Medicare can refuse to cover any medical services related to the injury until the equivalent of the entire settlement is expended on injury-related care.
Also, while money in your MSA account and any interest it earns isn’t taxed, any MSA money used for non-qualified expenses will be taxed and subjected to an additional 50% tax penalty.