READER PLEASE NOTE: The following articles were published between 1996 and 2002. They attempt to provide information regarding the statutory scheme and policy considerations which lie behind the decisions Medicare makes when the Medicare recipient (or someone who may become one in the foreseeable future) has access to some other form of medical insurance - especially workers’ compensation insurance.
Much of the information contained in this article is still correct and up-to-date. However, such things as Medicare premiums and also medical services which are covered change frequently. Furthermore, and most especially in the area of Medicare Set-Aside Trusts (or “WCMSA’s” as they are called), policy considerations more than a statutory regulatory scheme determine how Medicare will react to the particulars of a situation. Policy considerations change frequently.
Medicare publishes updates to publicize its current policies. Areas of particular concern to readers of the article below are:
- the various premiums charged by Medicare;- Medicare set-aside trusts: when to do them, when not to do them;- How, when and where to get Medicare’s pre-approval of a Medicare Set-Aside Trust;- the role played by the Medicare Coordination-of-Benefits Contractor (or “COB”);- the extent of Medicare coverage and important areas of medical services not covered by Medicare.Here are some helpful links to get current information in those areas:
Regarding Medicare premiums and co-insurance rates for 2009:
The when/when-not and how-to of a workers compensation Medicare Set Aside Trust
(WCMSA):
2009 Medicare coverages and considerations (the “Medicare and You” handbook for 2009):
Medicare’s website:
Contact information for the COB:
For a more current Life Expectancy Table than found in the articles see: http://www.ssa.gov/OACT/STATS/table4c6.html
Note: While the Social Security Actuarial Table whose URL is listed above may be used for purposes of Workers’ Compensation Offset Proration, attorneys dealing with Medicare Set Aside Trust Issues should be aware of the CMS policy memos dated May 20, 2008 and August 20, 2008, a brief summary of which is described below. See also the May 20, 2008 policy memo at: http://www.cms.hhs.gov/WorkersCompAgencyServices/Downloads/52008Memo.pdf &
The May 20, 2008 CMS policy memo is addressed to "Consortium Administrator for Financial Management and Fee-for-Service Operations". It states, in part:
"Effective with WCMSA submissions received by CMS' Coordination of Benefits Contract on or after July 1, 2008, CMS will only accept life expectancies obtained from the CDC [Centers for Disease Control] Table 1, Life table for the total population. The CMS will only use the CDC Table 1 in its WCMSA review process."
The May 20, 2008 CMS policy memo does not mention annuities or structured settlements or rated ages.
The August 20, 2008 CMS policy memo is addressed to the same "Consortium Administrator". It states, in part:
"To protect the Medicare Trust Fund, a set-aside relationship should be funded based upon the life expectancy of the individual unless the State law specifically limits the length of time that WC covers work-related conditions. Unless a submitter furnishes acceptable proof of a Rated Age for a claimant, CMS will estimate the claimant's remaining life expectancy using Actual Age. Acceptable proof of Rated Ages includes independent rated ages on the letterhead of an insurance carrier or settlement broker and a statement from the submitter that all rated ages obtained on the claimant have been included."
WHERE DOES AN ATTORNEY GO TO COMPROMISE A MEDICARE CLAIM FOR RECOVERY?
(The following information has been updated July, 2009)
For Medicare Set Aside Trust you may contact:
C.M.S.
P.O. Box 33849
Detroit Michigan 48232-5849
Or Call Coordination of Benefits Contractor: (800) 999-1118
For Third Party Lien/Repayment Issues you may contact:
MSPRC WC
PO Box 33831
Detroit, MI 48232-5831
Or Call: Medicare Secondary Payer Recovery Contractor (866) 677-7220.
Their website is: http://www.msprc.info.
