Cost Comparison Of Funding a Medicare Set-Aside Using A STRUCTURED SETTLEMENT

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Buck Harrell
8 years ago
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1 Cost Comparison Of Funding a Medicare Set-Aside Using A STRUCTURED SETTLEMENT LUMP SUM MSA $501, Life Only Temp Life Cash Refund Life Only Temp Life Cash Refund MSA SEED $ 69, $ 69, $ 69, $ 69, $ 69, $ 69, Annuity Cost* $296, $271, $317, $262, $252, $293, *Rates as of 7/8/2011 $341, $320, $387, $305, $291, $363, SAVINGS $159, $180, $113, $195, $209, $137, Percent savings 32% 36% 23% 39% 42% 28% Medicare Allocation is the amount that would have to be paid in a lump sum if MSA is not funded with a structured settlement. Seed Money is deposited into claimant s account at settlement and is determined by 2 years of annual cost plus the cost of the first surgery or durable medical equipment purchase. Annuity payments begin 1 year from allocation date and must continue for a period at least as long as the claimant s life expectancy minus 1 year. 1 Life expectancy based on the National Vital Statistics report, Volume 59, Number 9 Table 1 as required by CMS per memorandum of September 28, dkorch@epssg.com Page 1

67 $305,363.67 $291,632.67 $363,328.67 SAVINGS $159,473.33 $180,819.77 $113,578.77 $195,890.77 $209,621.77 $137,925.

2 Annuity Plans Annuity plans typically used for funding WC MSA allocations are shown below. Example: Female, Age 53, life expectancy = 27.9 years 1 1. Temporary life annuity Generally the least expensive annuity option, in this example the annuity would make payments for 27 years or until the death of the claimant, whichever is sooner. 2. Life annuity Payments would continue for the life of the claimant, even if the claimant lives longer than the 27-year life expectancy. 3. Life with Cash-Refund annuity Payments would continue for the life of the claimant, even if the claimant lives longer than the 27-year life expectancy. However, if the claimant dies before the total amount of payments to the claimant is equal to the annuity cost, the difference between the annuity cost and the amount paid will be refunded. This type of annuity is usually more expensive than either the temporary life or life annuity options, but the cost difference is sometimes small. Each case should be evaluated individually to determine the most cost effective alternative. 1 Life expectancy based on the National Vital Statistics report, Volume 59, Number 9 Table 1 as required by CMS per memorandum of September 28, dkorch@epssg.com Page 2

years or until the death of the claimant, whichever is sooner. 2. Life annuity Payments would continue for the life of the claimant, even if the claimant lives longer than the 27-year life expectancy.

3 MSA Account Administration Once the defendant decides to fund the MSA allocation, the issue arises as to who will administer the MSA account. There account can be administered by the claimant or by a professional administrator. There are also options that allow the claimant to self administer while getting assistance from a professional. 1. Self Administration Claimant deposits any funds received, including seed money and future periodic payments, in a segregated, interest-bearing account. Claimant pays for injury-related Medicare expenses from the account and provides an annual accounting to CMS. 2. Self Administration using Providio Medisolutions book and on-line tools This is self administration, but claimant or claimant s counsel can purchase the Providio MSA book for $100, which also includes a 1-year subscription (renewable) to an online tool (renewable) that aids claimants in tracking expenses and reporting to CMS. In the case of unrepresented claimant, a defendant might also consider purchasing and providing the book to claimant for the first year (or longer) to demonstrate that it helped the claimant understand and fulfill his obligations to CMS. 3. Assisted Self-Administration The claimant deposits any funds received and issues payments to medical providers, but uses the services of a professional administrator to assist in determining the correct amounts and payments to make. There are a number of companies which provide this service. Typical cost range: $100 - $750 per year, usually with a set-up fee in the first year. 4. Professional Administration The professional administrator invests the funds as well as makes payments to medical providers. Cost range: $300 - $2,000 per year, depending on the amount of the allocation. A typical fee schedule is shown below: Total MSA Account Amount Flat Annual Fee $1,000 to $25,000 $500 $25,001 to $75,000 $750 $75,001 to $100,000 $950 $100,001 to $200,000 $1,250 dkorch@epssg.com Page 3

Self Administration Claimant deposits any funds received, including seed money and future periodic payments, in a segregated, interest-bearing account.

4 $200,001 and higher $1,500 Page 4

5 Reversionary Interest for the employer In any settlement, there exists the possibility that the claimant might die unexpectedly a short time after the settlement. If a defendant has paid a substantial sum for the settlement, the death might result in the defendant having overpaid versus the amount that would have been paid with no settlement, or might result in a windfall for the claimant s estate. There are two ways an employer can guard against the overpayment. Annuity with a commutation or cash refund provision As previously shown, funding an MSA with an annuity results in a savings over what it would cost to pay the full amount of the allocation at settlement in a lump sum. An annuity can also provide protection in the form of a reversionary interest. With MSA funding, this most often takes the form of an annuity known as life with cash refund. With this type of annuity, if the claimant dies before the payments from the annuity are equal to the annuity cost, the difference would be paid in a lump sum to the defendant. For example, if the cost of the annuity is $100,000 and the claimant dies after only $40,000 of annuity payments have been made, the amount refunded would be $60,000. A life with cash refund annuity can be used whether the MSA account is administered by the claimant or professionally administered. A commutation provision provides for payment of the commuted value (present value) of the remaining annuity payments (versus the full value of remaining payments provided by a cash refund provision.) However, a commutation provision is less expensive than a cash refund option. Reversionary Interest in the Medicare Set Aside account The defendant can protect its potential exposure to overpaying the claim by retaining a reversionary interest in the Medicare Set Aside account. The reversionary interest would need to be established and documented at the time of settlement and would entitle the defendant to all or a set percentage of the funds in the account after all Medicare-related expenses have been paid. It is easier to protect the defendant s reversionary interest in a professionally administered MSA account that the defendant is paying for than a self administered account that might be available to the claimant s family upon his/her death. dkorch@epssg.com Page 5

in a windfall for the claimant s estate. There are two ways an employer can guard against the overpayment.

MEDICARE SET ASIDE SERVICES. Medicare Set Aside FAQs

MEDICARE SET ASIDE SERVICES. Medicare Set Aside FAQs MEDICARE SET ASIDE SERVICES Medicare Set Aside FAQs What Is a Medicare Set Aside? A Medicare set aside (hereinafter MSA) is a tool that allows a workers compensation claimant to preserve Medicare benefits