Why purchase a "MAP" for a "Workers' Compensation Medicare Set-Aside" (WCMSA)?
Primarily to keep the injured worker in a DISCOUNTED Pharmacy and Durable Medical Equipment (DME) program, thereby extending the life of their WCMSA funds and keeping them Medicare eligible!
With a structured settlement, all it takes is one hospital admission or a different prescription that was not projected for future medical care and “wham,” the WCMSA account is temporarily exhausted. Medicare becomes the primary payer and the beneficiary is responsible for charges (copays & co-insurance) and treatment/supplies Medicare does not cover. What’s more, only Medicare-approved providers can bill Medicare and many DME suppliers and some physicians are not Medicare-approved. For injured workers self-administering their WCMSA funds, it’s up to them to find discounts and handle all of the paperwork required by Medicare. But WHY, when our inexpensive MAP program can help with situations such as these!
Here is what Fidelity Fiduciary Company (FFC) can do for the injured worker at low cost to the payer:
- We will mail the beneficiary Medicare’s Self-Administration Kit and answer any questions they may have about how to fulfill their administrative duties to Medicare for one year. This will help them develop a credible relationship with Medicare from the very beginning. Once they are experienced, they are more apt to remain Medicare-compliant/Medicare-eligible throughout their life expectancy.
- Pharmacy and DME settlement funds (ONLY; not the Medical funds) are made payable to FFC, FBO the injured worker/Medicare beneficiary. We then invest these funds in an interest-bearing bank account and enroll them in our Pharmacy and Durable Medical Equipment (DME) Discount Program. This insures we only pay what is WC injury-related, Medicare-covered and below retail price and/or any Non-Medicare approved funds stipulated in the settlement. We will do this throughout the individual’s normal life expectancy. If prescriptions change, this could be a huge savings for the WCMSA account, which prevents the injured worker from having to pay out-of-pocket.
- We will provide the injured worker an Annual Financial Statement itemizing our payments and their savings throughout the year. They need this figure to complete the Attestation form that must be sent to Medicare annually. It is also excellent documentation should Medicare ever question their Rx/DME expenditures.