WCMSA Self-Administration
Guidance for Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) between Medicare and the Medicare beneficiary to take a portion of a Workers’ Compensation (WC) settlement and set those funds aside for all future work-injury-related medical expenses that are covered and would normally be paid by Medicare.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: October 08, 2019
A Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) is an agreement between Medicare and the Medicare beneficiary to take a portion of a Workers’ Compensation (WC) settlement and set those funds aside for all future work-injury-related medical expenses that are covered and would normally be paid by Medicare. The goal of creating a WCMSA is to set aside money from the settlement to cover those medical expenses related to settled injury or illness for which Medicare may not make payment. For additional information on the WCMSA, please see the WCMSA Reference Guide which is available in the Downloads section of the WCMSA page.
Medicare beneficiaries may choose to self-administer their CMS-approved WCMSA or have it professionally administered on their behalf.
Account Set-Up and Administration
If Medicare beneficiary decided to self-administer their WCMSA, they should review the Self-Administration Toolkit for WCMSAs available in the Downloads section at the bottom of this page. This Toolkit describes the process and guidelines for beneficiaries managing their WCMSA account and walks them through the set-up of their WCMSA through its depletion (exhaustion). Also available in the Downloads section are copies of the Account Expenditure for Lump Sum Account (Attestation Letter), Account Expenditure for Structured Annuity (Attestation Letter) and a Transaction Record Sample. Medicare beneficiaries can use the Transaction Record Sample (or a similar document) to keep track of all deposits to and withdrawals from your WCMSA account. The account expenditure letters are blank and can be used to submit the required annual attestation that the Medicare beneficiary correctly used the funds in the WCMSA account.
Where to Get Help
- For questions about annual attestations or annual accountings, contact the Benefits Coordination & Recovery Center (BCRC). See the Contacts page for BCRC phone numbers.
- For general information on Medicare’s recovery process, see the Beneficiary Services and Attorney Services pages.
- To view your Medicare claims or if you wish to submit an annual attestation electronically, register and log into your Medicare.gov account.
- For questions about Medicare’s coverage of a specific item, service, or prescription drug, or to help determine if you may pay for it from your WCMSA account, visit Medicare’s website.
- To request assistance from the CMS Regional Office that is assigned to your case, see the CMS Regional Offices for contact information.
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DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.