Our signature work
The future-care planmost planners skip.
Medical-cost planning prices a lifetime of future care, protects Medicare’s interest, and funds it inside the settlement — through life-care plans, Medicare Set-Asides, and structured funding. In catastrophic cases, future care is the largest part of the recovery.
Future medical costs
The life-care plan is how you prove it.
A life-care plan is the foundational document of long-term medical-cost planning. Unlike medical records, which document the past, it looks forward: a comprehensive, evidence-based projection of every future treatment, medication, surgery, therapy, piece of durable medical equipment, home modification, and attendant-care need over the injured person’s lifetime, with costs attached.
It is prepared by a Certified Life Care Planner — often a registered nurse, nurse practitioner, physician, or rehabilitation professional with specialized training — working from medical records, a client interview and home visit, and treating-physician input. A forensic economist then reduces the projected stream to present value. The same plan substantiates the future-damages claim, feeds the Medicare Set-Aside analysis, and grounds benefit preservation.
The disciplined sequence
Build it in the right order.
In a catastrophic case the order matters: a life-care plan first, then Medicare compliance, funding, and benefit preservation layered on top of it.
Build the life-care plan first
A Certified Life Care Planner prices every future treatment over the recipient’s lifetime; an economist reduces it to present value. Don’t settle before it’s complete — the settlement happens only once.
Layer Medicare Secondary Payer compliance
Reimburse Medicare for conditional payments it already made, protect Medicare’s interest in future care, and confirm the insurer’s Section 111 reporting.
Fund the set-aside
Where an MSA is appropriate, decide the amount and how to fund it — almost always evaluating a structured (seed + annuity) MSA, often with a rated age, for cost savings.
Preserve benefits and resolve liens
Coordinate a special needs trust for Medicaid/SSI eligibility and resolve Medicare, Medicaid, and ERISA liens — so the net recovery and benefits both survive.
Medicare Secondary Payer
The framework that drives everything.
The Medicare Secondary Payer (MSP) Act (42 U.S.C. §1395y(b)) makes Medicare a secondary payer whenever payment has been made or can reasonably be expected to be made under liability, no-fault, or workers’ compensation insurance. That single rule creates three distinct obligations.
The obligation to consider Medicare’s interests exists whether or not CMS ever reviews a set-aside. Ignoring it is not cost-free: it can mean denial of future injury-related Medicare coverage, reimbursement demands reaching up to the full settlement, and Section 111 reporting penalties.
Three MSP obligations
Conditional payments
Reimburse Medicare for past injury-related care it paid before settlement, recovered through the BCRC.
Future medical
Protect Medicare’s interest in future injury-related care it would otherwise cover.
Section 111 reporting
The insurer reports the settlement to CMS where a Medicare beneficiary is involved.
Medicare also reduces its recovery to account for the cost of procuring the settlement under 42 C.F.R. §411.37.
Set-asides — WCMSA vs LMSA
One is well-defined. One is not.
A Medicare Set-Aside reserves part of a settlement for future injury-related, Medicare-covered care. How CMS treats it depends entirely on whether the case is workers’ compensation or liability.
Workers’ compensation — WCMSA
Well-defined, with review thresholds.
CMS maintains detailed guidance for Workers’ Compensation MSAs in its WCMSA Reference Guide. Submission for CMS review is voluntary, but CMS will review a proposed amount once its workload thresholds are met:
- The claimant is a Medicare beneficiary and the total settlement is greater than $25,000; or
- The claimant has a reasonable expectation of Medicare enrollment within 30 months and the anticipated total settlement is greater than $250,000.
CMS stresses these are workload thresholds, not safe harbors: settling below them does not eliminate the duty to consider Medicare’s interests.
Liability — LMSA
Unsettled — handle with care.
For liability cases there is currently no formal CMS review process and no regulation requiring a Liability MSA. CMS withdrew its proposed liability future-medicals rule in 2022, and as of now nothing has replaced it. This is an area of genuine legal uncertainty — it should not be treated as settled law.
What does still apply is the underlying MSP duty not to shift future injury-related costs to Medicare. So rather than assume an LMSA is — or isn’t — required, the defensible approach is to document a reasoned analysis of Medicare’s future interest for the specific case.
Administration
Professional, or for life on your own.
CMS permits a recipient to self-administer an MSA where state law allows — but its WCMSA Reference Guide says professional administration is highly recommended.
The reason is the burden. Self-administration means keeping MSA funds in a separate, interest-bearing account, paying only Medicare-covered injury-related expenses at the correct price, keeping detailed records, coordinating with Part C and Part D plans, and filing annual attestations — every year, for life. A misstep can cause Medicare to deny injury-related coverage.
Why professional administration
- Compliance with CMS rules and correct annual attestation and exhaustion reporting.
- Provider and pharmacy network pricing that can extend the life of the fund.
- Lower risk of a Medicare denial of injury-related care.
- CMS especially recommends it where the recipient takes drugs it deems frequently abused.
Funding future care
Fund the set-aside with a structure.
CMS expressly permits funding an MSA as either a lump sum or a structured settlement. A structured MSA uses an initial “seed” deposit plus an annuity that replenishes the account each year for the recipient’s life expectancy — the same structuring discipline applied to future medical care.
How structured settlements work- Annuity funding can lower the present cost of paying for the same future care.
- A rated age, accepted by CMS as evidence of reduced life expectancy, can reduce the amount and duration required.
- Annual “temporary exhaustion” lets Medicare cover costs once a year’s funds run out, until the next deposit.
- The annual professional-administration fee can be funded through the structure too.
Coordinate the rest
Care planning never stands alone.
Medical-cost planning has to be coordinated with benefit preservation and lien resolution, or the client’s net recovery and benefit eligibility can be destroyed even after the care is priced correctly.
Benefit preservationBenefit preservation
Medicaid and SSI are means-tested; a first-party special needs trust under 42 U.S.C. §1396p(d)(4)(A) can hold the settlement — and may hold the MSA — without counting as a resource. SSDI and Medicare are not means-tested.
Lien resolution
Medicare conditional-payment liens, Medicaid liens, and ERISA or private health-plan liens must be resolved before distribution, with funds kept segregated until they are.
Common questions
Medical-cost planning, answered.
The questions attorneys ask most about future care and Medicare. For the full, sourced set, see our FAQ.
Read the full FAQA life-care plan is an evidence-based document that projects every future treatment, medication, surgery, therapy, piece of equipment, home modification, and attendant-care need over the injured person’s lifetime, with costs attached. It is prepared by a Certified Life Care Planner and often paired with an economist who reduces the stream to present value. In catastrophic cases it is usually the largest part of the damages.
A Medicare Set-Aside is a portion of a settlement reserved to pay future injury-related, Medicare-covered care, which must be spent down before Medicare pays for that care. It exists to satisfy the Medicare Secondary Payer obligation not to shift future injury-related costs to Medicare.
CMS reviews a proposed WCMSA when its workload thresholds are met: the claimant is a Medicare beneficiary and the total settlement is greater than $25,000; or the claimant has a reasonable expectation of Medicare enrollment within 30 months and the anticipated total settlement is greater than $250,000. CMS stresses these are workload thresholds, not safe harbors — submission itself is voluntary, and falling below them does not remove the duty to consider Medicare’s interests.
There is currently no formal CMS review process and no regulation requiring a Liability MSA; CMS withdrew its proposed liability future-medicals rule in 2022 and nothing has replaced it. This is an area of genuine legal uncertainty and should not be treated as settled. The underlying Medicare Secondary Payer obligation to protect Medicare’s future interest in liability settlements still applies, so the defensible approach is to document a reasoned analysis of that interest rather than assume an LMSA is or isn’t required.
CMS permits self-administration where state law allows, but its WCMSA Reference Guide says it is highly recommended that recipients use a professional administrator. Self-administration requires keeping funds in a separate interest-bearing account, paying only Medicare-covered injury-related expenses at the correct price, keeping records, and filing annual attestations — for life. Errors can cause Medicare to deny injury-related coverage.
Yes. CMS expressly permits funding an MSA as either a lump sum or a structured settlement. A structured MSA uses an initial seed deposit plus an annuity that replenishes the account each year, which can lower the present cost of funding future care and allows annual temporary exhaustion so Medicare picks up covered costs once a year’s funds run out.
A catastrophic case on your desk?
Bring us in before settlement — we’ll price the future care, protect Medicare’s interest, and fund it to last.