A person can have a “reasonable expectation” of Medicare enrollment within 30 months of settlement if they are at least 62 1/2 years old, have applied for SSDI, had their SSDI application denied but intend on requesting reconsideration and/or appealing the decision.

CMS allows parties to seek what’s called an “Amended Review” if the amount of the new MSA is different from the original by at least 10% or $10,000. Situations where this may apply include, when a surgery is no longer recommended, a prescription discontinued, or an implantable device removed.

As of July 17, 2025, they will no longer review and approve a zero-dollar WCMSA. Section 4.2 of the WCMSA Reference Guide that was released on January 17, 2025, confirms that a WCMSA is not necessary where: 1) you have a fully contested claim where no medical or indemnity payments have been made or 2) you get a ruling on the merits, that the workers’ compensation insurer does not owe any additional medical or indemnity benefits, medical and indemnity benefits are not actively being paid, and the settlement agreement does not allocate certain amounts for specific future medical services.

Submission of a Medicare SetAside to CMS, is never legally required. While submission to CMS is often the best strategy for your client, there are also certain scenarios where submission may not make sense, and could even be at odds with your client’s best interests. For example, submission may not be the best solution, if you are settling on a contested basis because of credibility issues, or where a surgery has been recommended that your client will never have. At MSA Services, we take a different approach to MSP compliance. We are advocates first. We provide our clients with a comprehensive analysis of the law and a clear breakdown of the benefits and risks of every strategic option. Our goal is to empower you to make the best decisions for a successful settlement, every time.

Future Medical Cost Projections estimate the medical, surgical and prescription expenses a claimant is likely to incur over their lifetime. Future Medical Cost Projections provide actual pricing and coding to justify future medical specials in settlement demands. Studies show that attorneys get higher settlement offers when a future medical cost projection is used. Future medical cost projections are an affordable alternative to a life care plan. For as little as $800 we can help you maximize the future medical aspect of your claim. They can even be used by defense counsel to refute inflated demands by providing actual pricing data.