The arrangement reserves settlement proceeds for future treatment Medicare would cover, protecting Medicare's secondary payer interest. CMS review is available above workload review thresholds but is not mandatory.
Funds must be exhausted before Medicare pays.
Alternative Names:
WCMSA|Workers' Compensation Medicare Set-Aside
Why it Matters?
CMS review is voluntary rather than required, which parties frequently misunderstand as a mandatory step, and settlements may close without submission provided Medicare's interest was reasonably considered. Submission provides safe harbor but adds months to the timeline. Where the claimant is not yet a beneficiary but reasonably expects enrollment, the obligation still attaches, which catches settlements with claimants approaching eligibility.
Frequently Confused with
Related terms
Frequently asked questions
Is CMS review mandatory?
Does the obligation apply before enrollment?
