Do I Need An MSA?
The Center for Medicare and Medicaid Services (CMS) will only review and approve MSA's that meet the following criteria:
(1) Wherein the injured individual is currently eligible for Medicare and the settlement amount exceeds $25,000
(2) The settlement value is over $250,000 (inclusive of indemnity, attorney fees and costs) AND the injured individual is reasonably expected to become entitled to Medicare within 30 months (e.g. the injured individual is currently receiving Social Security Disability benefits).
| Existing Claim at Time of Settlement | MSA Appropriate |
| Claimant is not enrolled in Medicare at the time of
settlement and Total amount of settlement* is greater than $250,000 and There is reasonable expectation of Medicare enrollment within 30 months of settlement. |
YES |
| Claimant is enrolled in Medicare at
the time of settlement and Total amount of settlement* is greater than $25,000. |
YES |
| Claimant is enrolled in Medicare at the time of
settlement and Total amount of settlement* is $25,000 or less |
NO |
| Claimant is not enrolled in Medicare
at the time of settlement and Total amount of settlement* is $250,000 or less and There is no reasonable expectation of Medicare enrollment within 30 months of settlement. |
NO |
| Claimant is not enrolled in Medicare at the time of
settlement and Total amount of settlement* is greater than $250,000 and There is no reasonable expectation of Medicare enrollment within 30 months of settlement. |
NO |
| Claimant is not enrolled in Medicare
at the time of settlement and Total amount of settlement* is $250,000 or less and There is reasonable expectation of Medicare enrollment within 30 months of settlement. |
NO |
