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Custodial Accounts
Self Administered Accounts


We recommend this option for smaller settlements and/or the more sophisticated client. This gives the client a more hands-on responsibility of their MSA. Affiance provides them with an manual which provides extensive information regarding Medicare Set Asides. The claimant then uses this manual to determine if the servies they are receiving are indeed, injury-related and Medicare approved. The client assumes the responsibility for issuing payment of medical services and submitting required annual accountings to CMS.

The unprecedented growth of Medicare Set Asides has had a profound effect in securing the integrity of the Medicare trust (fund). However, in Workers’ Compensation (and liability) settlement cases, the agreement of all parties (insurers, plaintiffs, attorneys and Medicare) often falls short of its intended purpose. This has resulted in no standardized and secure means of managing and reporting the MSA fund usage to ensure compliance with Medicare’s provisions.

The need for this mechanism creates instant value for all parties:

Plaintiff/Claimant

  • Does not jeopardize benefit eligibility;
  • Provides guidance for use of MSA funds; and
  • Removes the burden of reporting.

Insurer and Attorneys
  • Provides peace of mind because the plaintiff is provided with a trusted resource to manage future care and avoid post settlement liability.

Medicare
  • Insures the approved allocated funds are used for their intended purpose, and;
  • Provides a uniform method to comply with disbursement and reporting obligations, as well as protecting ongoing entitlement to Medicare.


Medicare laws and regulations provide that the responsibility for the future medical expenses associated with your injury should not be shifted to Medicare from the responsible party. For that reason, Medicare will not pay for any medical expenses related to your injury after a settlement, until the time the portion of the settlement allocated to future medical expenses covered by Medicare is fully exhausted. That is why a portion of your settlement must be “set aside” to pay for the future medical expenses associated with the injury for which you are settling, which would otherwise be covered by Medicare ( 42 C.F.R. 411.46).

A Medicare Set-Aside Allocation amount is determined through the detailed analysis of your particular case. Medicare considers the allocation to be the primary fund for paying Medicare covered expenses for your settlement-related injury. Once the allocation amount is exhausted, Medicare becomes the primary payor of the Medicare covered expenses for those settlement-related injury.

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