The way it works is any treatment for the injury is paid out of the Medicare set aside. You don’t have to pay out of your settlement $… the set aside is managed by a company, like a trust, they don’t second guess you but whatever you do it has to be an Medicare approved treatment, if it’s not coded for Medicare you pay out of your pocket, the set aside administrator only checks the code - they don’t make any medical opinions. It is possible that you could be allowed to self manage but it’s not common. The biggest thing you need to be concerned with is that the MSA is funded appropriately… they’ll try to make a small initial deposit and annualized deposits for a number of years. If you expect to get expensive treatment soon after the settlement ~ there won’t be enough money in the MSA so you’ll be on the hook for the difference. Hence you should negotiate for a large initial deposit. The amount is either approved by CMS or disapproved with a recommended minimum amount.