03.08.07
Zero Dollar Set-Asides
What is a Zero Dollar Medicare Set-Aside?
A zero dollar Medicare set-aside may arise in one of two situations.
No Future Medicare-Covered Medical Treatment
First, a zero dollar Medicare set-aside may be appropriate in a case where no future Medicare-covered medical treatment is projected for an undisputed work injury. In this case, the claimant will typically have been released from their physician’s care and will not have any reasonably foreseeable Medicare-covered medical treatment. This does not mean that the claimant does not have any projected future medical treatment, but that none of the projected care would otherwise be Medicare-covered. A zero dollar Medicare set-aside under these circumstances does not require CMS approval.
