When to Consider Medicare's Interests

SCENARIO I

Is the claimant a Medicare beneficiary?

YES

If the total settlement amount is greater than $25,000, CMS must pre-approve an MSA proposal

If the total settlement amount is $25,000 or less, a pre-approved MSA proposal is not necessary; however, Medicare's interests still must be considered

SCENARIO II

If the total settlement amount is greater than $250,000 AND there is a reasonable expectation of the claimant becoming a Medicare beneficiary within 30 months from the date of the settlement, CMS must pre-approve an MSA proposal.

REASONABLE EXPECTATION includes:

1. Currently receiving SSD benefits
2. Has applied for SSD benefits
3. Previously received SSD benefits and remains eligible
4. Denied SSD benefits, but is appealing denial
5. 62.5 years old or older
6. End Stage Renal disease

If the claimant meets one or more of these criteria and the total settlement amount is $250,000 or less, a pre-approved MSA proposal is not necessary; however, Medicare's interests still should be considered

Include the following in calculating the TOTAL SETTLEMENT AMOUNT:

1. Money paid at time of settlement for future medical expenses, including prescription medications (MSA allocation)
2. Money paid at time of settlement for indemnity/vocational benefits
3. Advances paid as part of settlement
4. Attorney fees and costs paid in settlement
5. Medicare conditional payment claims, if any
6. Money paid in prior settlement or award
7. Third-party settlement amount including value of liens waived

If questions regarding the information arise or you are uncertain whether an MSA is needed, please contact us:

Bleakley, Cypher, Parent, Warren & Quinn, P.C.

Toll-Free: (866) 677-9243

Website: www.bcpwq.com

NO

Look to see if the claimant falls under SCENARIO II below

You must secure a conditional payment lien letter from the MSPRC

AFTER SETTLEMENT

You must secure a final demand letter from the MSPRC