US · guidance
CMS Pub. 100-05, ch. 1, § 20.4.1
Workers’ Compensation Medicare Set-aside Arrangements (WCMSAs)
WC insurers, agencies, and attorneys have significant responsibilities under the MSP
provisions of the Social Security Act to protect Medicare’s interests when resolving WC
cases. Because Medicare does not pay for an individual’s WC -related medical services
and/or prescription drugs when the individual receives a WC settlement, judgment, or
award that includes funds for future medical and/or prescription drug expenses, it is in the
best interest of the individual to consider Medicare at the time of settlement, as required in
1395y(b)(2). For this reason, CMS recommends that parties to a WC settlement set aside
funds, known as WC Medicare Set -Aside Arrangements (WCMSAs) for all future medical
and/or prescription drug services related to the WC injury or illness/disease that would
otherwise be reimbursable by Medicare.
See Pub. 100-05, Chapter 1, §20, for the definitions of a "Set- Aside Arrangement,” “Workers’
Compensation Medicare Set-Aside Arrangement.”
History
(Rev. 11755, Issued:12-21-22, Effective: 01-23-23, Implementation: 01-23-23)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
7383be15e20c478f75c70e71bb0e647bec93d2324872e9e94fd5020cbde3ad85
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