Workers’ Compensation Medicare Set-aside Arrangements (WCMSAs)

20.4.1 - Workers’ Compensation Medicare Set-aside Arrangements (WCMSAs) (Rev. 11755, Issued:12-21-22, Effective: 01-23-23, Implementation: 01-23-23) WC insurers, agencies, and attorneys have significant responsibilities under the MSP provisions of the Social Security Act to protect Medicare’s interests when resolving WC cases. Because Medicare does not pay for an individual’s WC-related medical services and/or prescription drugs when the individual receives a WC settlement, judgment, or award that includes funds for future medical and/or prescription drug expenses, it is in the best interest of the individual to consider Medicare at the time of settlement, as required in 1395y(b)(2). For this reason, CMS recommends that parties to a WC settlement set aside funds, known as WC Medicare Set-Aside Arrangements (WCMSAs) for all future medical and/or prescription drug services related to the WC injury or illness/disease that would otherwise be reimbursable by Medicare. See Pub. 100-05, Chapter 1, §20, for the definitions of a "Set- Aside Arrangement,” “Workers’ Compensation Medicare Set-Aside Arrangement.”