The Zero Dollar Medicare Set-Aside: A Budget-Friendly Mystery

Let’s talk about a little-known gem in the world of Medicare set-asides: the infamous zero dollar set-aside. Now, you might be wondering, “What in the world is a zero dollar Medicare set-aside?” A zero dollar set-aside is when it is determined that, after careful analysis, you don’t need to set aside any funds for future medical expenses related to a workers’ compensation claim.

So, how does one end up with a zero dollar figure?

While it may sound like a punchline, a zero dollar set-aside can actually be a win-win. It signals that the injured party’s future medical needs are either fully covered by other means or simply nonexistent.

However, before you start celebrating with confetti and streamers, remember that this zero dollar magic doesn’t happen for everyone. It requires thorough documentation and a keen eye for detail.

According to the WCMSA Reference Guide, Medicare’s interests must be protected, which means that if a workers’ compensation settlement doesn’t adequately consider Medicare’s interests, the consequences could be dire. Medicare may refuse to pay for services related to the workers’ compensation injury until the entire net settlement amount has been exhausted. Yikes!

And here’s where it gets even more interesting. Starting July 17, 2025, the Workers’ Compensation Review Contractor (WCRC) will no longer accept or review WCMSA proposals with a zero dollar allocation. As if navigating the complex world of Medicare set-asides wasn’t challenging enough, now we have to be extra careful to ensure that any zero dollar allocations are backed by solid documentation.

Just remember to keep an eye on those upcoming changes, because sometimes, the only thing more unpredictable than the world of WCMSAs is… well, your March Madness bracket picks!

If you need a Zero MSA or have questions about one, contact info@allankoba.com today.

 

References:

CMS WCMSA Reference Guide:

https://www.cms.gov/files/document/wcmsa-reference-guide-version-42.pdf

CMS Alert regarding July change: https://www.cms.gov/medicare/coordination-benefits-recovery/workers-comp-set-aside-arrangements/whats-new