How do I Start? Upon receipt of a copy of the MSA approval letter from CMS along with a copy of your Medicare card, the account will provide you with an Affiance (custodial account) card to be used for billing purposes for all Medicare-approved (and injury related) medical services and costs. If you are not yet Medicare entitled, notification of when entitlement will begin is required.

When do I use the Custodial account? The funds in your Medicare Set-Aside Account (MSA) shall only be used for those Medicare covered medical expenses associated with your settlement-related injury. If you have any questions about what Medicare covers please refer to the "2008 Medicare & You," (available at www.medicare.gov) which lists services that are and are not covered by Medicare or please call 1-800-MEDICARE.

How much money is placed in the account? Once approved by CMS, the predetermined amount of money will be transferred to the account for administration on your behalf for future Medicare-covered (and injury-related) medical care.

What is seed money? Every account must be seeded with a minimum of the first two years of the approved annualized set aside (for expenses) in addition to the cost of the first surgical procedure, medical testings and/or replacements. The "seed money" requirements change periodically, but you can rest assured that Affiance will use the most recent CMS requirements to protect your interests (and those of Medicare). If the MSA is not annualized then the entire cash amount will be deposited.

How do I know how much is left in the account? Affiance will provide annual reporting as required by the Centers for Medicare & Medicaid Services (CMS) to document what is spent from the account each year. You will be provided a copy of that report. If you have questions during a calendar year, you may contact Affiance, and we will give you the most updated account balance information.

What happens if I use all of the money? When the set-aside funds are spent down and a final accounting has been given to CMS, Medicare will begin to pay for any Medicare-covered medical treatment received as a result of the injury related to your settlement.

What happens if I die? In the event you die before the funds in the MSA Custodial Account are totally exhausted, Affiance will keep the account open for 180 days from the date of death to allow any outstanding bills to be paid. Thereafter, any proceeds remaining in your MSA Custodial Account will be paid to your estate, unless an applicable state law provides for other arrangements, such as a beneficiary designation.

Who is the remainder beneficiary? The beneficiary is designated in the custodial agreement and can be a family member, family members, or an estate.

Can the remainder beneficiary be a charity? We believe so. There appears to be no Medicare rules concerning who can receive MSA funds after the beneficiary’s death.

What about the interest earned? The interest earned is added to the MSA funding and used to cover your expenses as required by CMS. It cannot be used for any reason outside of MSA parameters.

Who is taxed on the growth? If a Form 1099-INT for the interest earned on a MSA account is received, an amount equal to the amount of incremental tax may be withdrawn by the administrator as a cost that is directly related to cover the additional tax liability. Such documentation should be submitted along with annual accounting. After the MSA Custodial Account expires, income generated from this account would likely be taxed to the remainder beneficiary.

How do I pay for injury related expenses not covered by Medicare? Monies designed for other medical expenses outlined in the Workers’ Compensation or liability settlement document can be used for these expenses. Injury related expenses not covered by Medicare can not be paid from the MSA Custodial Account.

How much can a provider charge for related services? Currently many states set fee schedules that regulate the maximum reimbursement values allowable under Workers' Compensation laws for medical treatment performed by healthcare providers. For Medicare Set-Aside accounts, we review bills according to the fee schedule used in computing your Workers’ Compensation or liability settlement. CMS advises us that the method by which the MSA amount is calculated would be the expected method of payment to the providers (i.e. if the MSA amount is determined by using Workers’ Compensation rates, the Custodian should pay providers according to the fee schedule of the state where settlement was approved, if usual and customary rates were used then payment will reflect same). CMS is quick to point out, however, that the providers may not agree to those rates, and CMS will not enforce them against the providers. To the extent possible, Affiance will negotiate rates with pre-approved medical care providers, to minimize the risk of provider non-acceptance of the Affiance rates.

Does Medicare approve services? Yes, the services rendered must be covered items under Medicare coverage guidelines. When the annual accounting is reviewed by CMS each year, this is one item that CMS representatives will be looking at to assure the MSA funding is being utilized properly.

Who does the annual reporting and accounting? On your behalf, Affiance will submit an annual accounting to CMS and the appropriate fiscal intermediary for each calendar year no later than March 1 of the following year. Within 60 days of your MSA Custodial Account being exhausted, Affiance will notify CMS and the appropriate fiscal intermediary as well as submit a final accounting.

What if I go back to work and get insurance? The MSA Custodial Account funds must be used as discussed above, as long as you are a Medicare beneficiary; or may be expended for medical expenses specified in the MSA until Medicare entitlement is re-established or the MSA Custodial Account is exhausted. You can return to work and obtain other insurance while still on Medicare, in certain situations. The bottom line is: If you are a Medicare beneficiary and have settled your Workers’ Compensation or liability claim, then the MSA Custodial Account funds need to be used pursuant to CMS guidelines.

What if I have other coverage (i.e. VA benefits)? Your MSA funds must still be used to cover injury-related expenses that would otherwise be covered by Medicare. You can utilize your VA benefits for other medical care pursuant to their coverage guidelines. An MSA Custodial Account is still required by CMS even when VA coverage is in effect.

What if I get better? Affiance Partners cannot release or reduce your remaining set-aside proceeds without approval from CMS. If your treating physician concludes that your medical condition has substantially improved, then you may submit a written request to the appropriate CMS Regional Office (RO) asking for a reduction of your Medicare Set Aside arrangement. This request must include supporting documentation from the treating physician(s) that justify a 25% reduction and may not be submitted until at least 5 years after a previous CMS approval. Once the RO receives all pertinent documentation, your request will be evaluated and a decision will be made. The new RO decision is final and is not subject to administrative appeal.

What are the fees and who pays? Our fees and costs are contained on page seven of your MSA Custodial Agreement. Who pays the fees should be decided as part of the settlement process.

What if CMS’ rules and regulations change? The MSA Custodial agreement will be determined by the most recent CMS memo.

When do I use the Self Admin account? The funds in your Medicare Set-Aside Account (MSA) shall only be used for those Medicare covered medical expenses associated with your settlement-related injury. If you have any questions about what Medicare covers please refer to the "2008 Medicare & You," (available at www.medicare.gov) which lists services that are and are not covered by Medicare or please call 1-800-MEDICARE.

What happens if I use all of the money? When the set-aside funds are spent down and a final accounting has been given to CMS, Medicare will pay for any Medicare-covered medical treatment received as a result of the injury related to your settlement.

What happens if I die? In the event you die before the funds in the MSA Account are totally exhausted, your estate should keep the account open for 180 days from the date of death to allow any outstanding bills to be paid. Thereafter, any proceeds remaining in your MSA Account will revert to a designated beneficiary or your estate, unless an applicable state law provides for other arrangements.

Who is the remainder beneficiary? A reminder beneficiary can be a family member, family members, or an estate.

Can the remainder beneficiary be a charity? We believe so. There appears to be no Medicare rules concerning who can receive MSA funds after the beneficiary’s death.

What about the interest earned? The interest earned is added to the MSA funding and used to cover your expenses as required by CMS. It cannot be used for any reason outside of MSA parameters.

Who is taxed on the growth? If a Form 1099-INT for the interest earned on a MSA account is received, an amount equal to the amount of incremental tax may be withdrawn by the administrator as a cost that is directly related to cover the additional tax liability. Such documentation should be submitted along with annual accounting

How do I pay for injury related expenses not covered by Medicare? Monies designed for other medical expenses outlined in the Workers’ Compensation or liability settlement document can be used for these expenses. Injury related expenses not covered by Medicare can not be paid from the MSA Account.

How much can a provider charge for related services? Currently many states set fee schedules that regulate the maximum reimbursement values allowable under Workers' Compensation laws for medical treatment performed by healthcare providers. For Medicare Set-Aside accounts, you should review bills according to the fee schedule used in computing your Workers’ Compensation or liability settlement. CMS advises us that the method by which the MSA amount is calculated would be the expected method of payment to the providers (i.e. if the MSA amount is determined by using Workers’ Compensation rates, you should pay providers according to the fee schedule of the state where settlement was approved, if usual and customary rates were used then payment will reflect same). CMS is quick to point out, however, that the providers may not agree to those rates, and CMS will not enforce them against the providers

Does Medicare approve services? Yes, the services rendered must be covered items under Medicare coverage guidelines. When the annual accounting is reviewed by CMS each year, this is one item that CMS representatives will be looking at to assure the MSA funding is being utilized properly.

Who does the annual reporting and accounting? You must submit an annual accounting to CMS and the appropriate fiscal intermediary for each calendar year no later than March 1 of the following year. Within 60 days of your MSA Account being exhausted, you must notify CMS and the appropriate fiscal intermediary as well as submit a final accounting.

What if I go back to work and get insurance? The MSA Account funds must be used as discussed above, as long as you are a Medicare beneficiary; or may be expended for medical expenses specified in the MSA until Medicare entitlement is re-established or the MSA Account is exhausted. You can return to work and obtain other insurance while still on Medicare, in certain situations. The bottom line is: If you are a Medicare beneficiary and have settled your Workers’ Compensation or liability claim, then the MSA Account funds need to be used pursuant to CMS guidelines.

What if I have other coverage (i.e. VA benefits)? Your MSA funds must still be used to cover injury-related expenses that would otherwise be covered by Medicare. You can utilize your VA benefits for other medical care pursuant to their coverage guidelines. An MSA Account is still required by CMS even when VA coverage is in effect.

What if I get better? Affiance Partners cannot release or reduce your remaining set-aside proceeds without approval from CMS. If your treating physician concludes that your medical condition has substantially improved, then you may submit a written request to the appropriate CMS Regional Office (RO) asking for a reduction of your Medicare Set Aside arrangement. This request must include supporting documentation from the treating physician(s) that justify a 25% reduction and may not be submitted until at least 5 years after a previous CMS approval. Once the RO receives all pertinent documentation, your request will be evaluated and a decision will be made. The new RO decision is final and is not subject to administrative appeal.

What are the fees and who pays? Our Self Administration fee is $750 and is paid by the beneficiary or on his behalf.