Free medicare_set-aside_lss_guidelines-09072007.xls - Nebraska

Guidelines for Medicare Set-Aside Arrangements in Lump Sum Settlements
Medicare status and lump sum settlement amount:
Medicare eligible or current beneficiary, and settlement amount is over $25,000.00 (current CMS review threshold). Medicare eligible or current beneficiary, and settlement amount is under $25,000.00.

Does the application need to address Medicare's interest?
YES.

Is the CMS letter required prior to approval of the application?
YES.

Can the set-aside amount be What language must be used used in calculating indemnity in the proposed order of approval? due?
NO. Set-aside amounts do not count as indemnity. Settlement amount alone must be sufficient to cover the indemnity due. NO. Set-aside amounts do not count as indemnity. Settlement amount alone must be sufficient to cover the indemnity due. NO. Set-aside amounts do not count as indemnity. Settlement amount alone must be sufficient to cover the indemnity due. YES. Any set-aside would be voluntary and the entire amount can be used to calculate indemnity coverage. Settlement amount and set-aside amounts listed separately. For example, "upon payment of $50,000.00 plus $10,000.00 to fund a Medicare Set-Aside . . ." Settlement amount and set-aside amounts listed separately. For example, "upon payment of $15,000.00 plus $1,000.00 to fund a Medicare Set-Aside . . ." Settlement amount and set-aside amounts listed separately. For example, "upon payment of $255,000.00 plus $50,000.00 to fund a Medicare Set-Aside . . ." Total amount can include any voluntary set-aside funds.

YES.

NO (below threshold).

YES. Reasonable expectation¹ of Medicare enrollment within 30 months and settlement amount is over $250,000.00. Reasonable expectation¹ of Medicare enrollment within 30 months and settlement amount is under $250,000.00.

YES.

NO. Parties do not need to NO (below threshold). address Medicare's interests when claimant is not Medicare eligible or current beneficiary, and the settlement is below the CMS review threshold. NO.

NO. No reasonable expectation¹ of Medicare enrollment within 30 months, regardless of settlement amount.

YES. Any set-aside would be voluntary and the entire amount can be used to calculate indemnity coverage.

Total amount can include any voluntary set-aside funds.

¹One has a "reasonable expectation" of Medicare enrollment within 30 months when: he/she has applied for SSDI (becomes eligible for Medicare after receiving SSDI for 24
months) OR he/she is age 62.5 (will be eligible when he/she turns 65, which is within 30 months) OR he/she is appealing a denial of an application for Social Security benefits.
Revised: 9/7/2007