Three Medicare Terms You See All the Time (And What They Mean) Part II
Last month, we shared three Medicare terms that often confuse our clients. This month, we're decoding a few more.
In our 25 years of professional administration, we’ve noticed that people hesitate to ask crucial questions to avoid admitting their confusion.
Do any of these sound familiar?
Why is Medicare involved in what my doctor charges?
Why did my pharmacy hand me a different pill?
How do I use my Medicare Set-Aside properly?
If you've ever nodded along on a call only to Google a term afterward, you're in good company.
Medicare isn’t intuitive, and there’s no shame in admitting you didn’t memorize every single term the moment settlement day came.
1. What is an MSA Allocation and who prepares this document?
A Medicare Set-Aside Allocation is a detailed document that calculates and sets aside a specific portion of a workers’ compensation settlement to pay for future, injury-related medical treatment.
A Medicare Set-Aside Allocation is typically prepared by a certified MSA allocation expert, nurse consultant, life care planner or specialized Medicare compliance company. These certified professionals perform medical records review and cost calculations in order to project future injury-related medical and pharmaceutical costs.
2. What is a Workers’ Compensation Fee Schedule?
It is an official list that sets the maximum payment amounts allowed for medical treatment, services and supplies given to workers hurt on the job. The schedule defines the highest price allowed for a specific medical procedure. Most U.S. states manage their own fee schedules. A Medicare Set-Aside pays at the worker’s compensation fee schedule rate for the particular state where the services are performed.
3. What is Generic Substitution?
Generic substitution is when a pharmacy dispenses a lower-cost, FDA-approved generic drug instead of a more expensive brand-name medication. This substitute will share the same active ingredients, dosage, and strength as your prescribed medication while saving you money. In fact, many Medicare Prescription Drug Plans require or encourage generic substitution.
According to the FDA, generics can cost up to 85% less than their brand-name versions when several generic makers compete.
There's no such thing as a silly Medicare question
If any of these terms were unfamiliar to you, you’re in the right place.
As the oldest professional administration in the country, we have answered lots of questions, and we are here to answer yours as well.
Have a question? Reach out to our team and let’s sort it out together.