What happens if the Medicare Set-aside proposal received after January 1, 2006 does not include an amount for future prescription drug treatment?
A71. If the Medicare Set-aside proposal does not include an amount for future prescription drug treatment, and the current treatment records indicate that the injured party has been prescribed drugs and/or may need prescription drugs due to the work or accident related injury or illness in the future, CMS will deem the submission as not adequately considering Medicare’s interests. If the cover letter does not include an amount for future prescription drug treatment, and there is no indication in the current treatment records that the injured worker will need future treatment with prescription drugs related to the workers’ compensation injury, then CMS will accept that Medicare’s interests have been adequately considered. Medicare will then pay primary for future prescription drugs if the injured worker has enrolled in a Medicare prescription drug plan and does not have any other coverage that is primary to Medicare.
Related Questions
- Does the injured party have to resubmit the Medicare Set-aside proposal after January 1, 2006 if CMS has already issued a written opinion as to the total Medicare Set-aside amount?
- Should Medicare Set-aside submitters include an amount for future prescription drug expenses if the injured party has not enrolled in a Part D plan?
- What happens if the Medicare Set-aside proposal received after January 1, 2006 does not include an amount for future prescription drug treatment?
