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Those who obtain a workers’ compensation settlement for future medical expenses must create a Medicare Set-Aside (MSA) Account to preserve their eligibility for Medicare. This separate, interest-bearing account pays for medical costs related to the worker’s injury. After the funds are exhausted, Medicare provides coverage for medical fees related to the injury.
Failing to establish an MSA can have significant consequences for Medicare eligibility. Neglecting to create an MSA can result in losing Medicare, as well as means-tested government benefits like Medicaid. In certain cases, not using an MSA following a settlement can lead to liability.
Individuals who receive settlements or judgments to cover future medical care must use these funds for that purpose to preserve Medicare coverage. For these expenses, Medicare is not the primary payer. Payments for the injury kick in only after the account is depleted and the beneficiary files a report with the Medicare Secondary Payer (MSP) Recovery Contractor. (Learn more about the Medicare Secondary Payer Act.)
Receiving a settlement for future medical expenses without setting up an MSA jeopardizes Medicare eligibility. Someone who ignores the requirement to create an MSA could forfeit Medicare coverage entirely. This could mean losing coverage for all medical expenses, including those unrelated to the injury.
If Medicare acts as the primary payer – meaning that Medicare pays first – when funds should have come from workers’ compensation, Medicare has a right of action. It can take legal action against the primary payer responsible for the payment, as well as those who received Medicare’s funds.
When beneficiaries are unaware of the rules and fail to create an MSA, they could lose coverage.
Not having an MSA, or setting one up that is ineffective, can also make individuals ineligible for means-tested benefits such as Supplemental Security Income (SSI) and Medicaid.
The Social Security Administration counts settlement funds as assets. Without a proper MSA, a person who acquires money to cover prospective medical costs following an accident could lose their public benefits.
Increases in assets can also disqualify beneficiaries of the following programs:
Supplemental Nutrition Assistance Program (SNAP)
Temporary Assistance for Needy Families (TANF)
Low-Income Home Energy Assistance Program (LIHEAP)
People who obtain workers’ compensation settlements can continue to receive means-based benefits, along with Medicare, when they have a well-structured MSA. According to the Special Needs Alliance, embedding a special needs trust (SNT) within an MSA can allow a person to continue accessing government benefits. This is because the funds in an SNT are not countable assets.
The Centers for Medicaid and Medicare Services (CMS) requires that workers’ compensation settlements reasonably consider Medicare’s interests. A workers’ compensation settlement requires a person to create an MSA. If they fail to do so, they could face legal consequences for breaching their settlement agreement.
CMS can also obtain restitution from anyone involved in the settlement, including the worker, workplace, insurance companies, and attorneys.
Creating and maintaining an MSA can be complex. If you wish to keep your Medicare eligibility while receiving compensation for an injury, working with an attorney to help you set up and manage an MSA is critical.
Consider consulting with a special needs planning attorney like Sharek Law Office. We can help you stay eligible for Medicare after acquiring a workers’ compensation settlement. Call our office at 412-347-1731 or click here to schedule a complimentary 15-Minute Call with our staff to discuss your needs today.
For more information about Medicare Set-Asides, check out the following articles:
This article is a service of Sharek Law Office, LLC. We don’t just draft documents; we ensure you make informed and empowered decisions about life and death, for yourself and the people you love. That's why we offer a Life and Legacy Planning Session, during which you will get more financially organized than you’ve ever been before, and make all the best choices for the people you love. You can begin by calling our office today to schedule a Life and Legacy Planning Session and mention this article to find out how to get this $750 session at no charge. Please note this is educational content only and is not intended to act as legal advice.
As we journey through life, many people find themselves facing one of the most pressing concerns: ensuring that they provide care and support to their loved ones, particularly their aging parents, as they transition into their senior years. Long-term senior care frequently raises questions and concerns, with one of the most common worries being, What if my parents run out of money?The cost of senior care services can indeed be a significant burden on families. Many are apprehensive about the affordability of these services and the potential financial strain they might impose. This is where a comprehensive continuum of care approach, like the one offered by Grace Pointe of Greeley, can make all the difference.Tailored Care for Your Unique NeedsOur team of experienced care professionals adopts a personalized approach to assess the specific care needs of each resident. We commit to ensuring that you dont pay for services that you or your loved one dont need. This ensures that you wont bear unnecessary costs, and your loved ones will receive the appropriate level of care to enhance their quality of life.If the affordability of long-term senior care concerns you, Grace Pointes approach is here to help. We dedicate ourselves to providing the right care at the right cost, supporting both your financial peace of mind and your loved ones well-being.To learn more about our long-term senior care services and our continuum of care approach, visit our Grace Pointe of Greeleys Long-Term Senior Care Services page.Frequently Asked Questions About Long-Term Senior CareAt Grace Pointe, we understand the financial concerns that come with long-term senior care, and were here to put your mind at ease. Our continuum of care services is designed to ensure affordability while providing your loved ones with the precise level of care they need. We understand that every individual is unique, and their care requirements can vary greatly which is why we have compiled this list of FAQs about long term senior care services below.What is long-term senior care, and when is it needed?Long-term senior care is a comprehensive service designed to provide assistance and support for seniors who may require help with daily activities due to age-related challenges or medical conditions. It becomes necessary when individuals find it increasingly difficult to maintain their independence and well-being.How do I know which type of long-term senior care is suitable for my loved one?Our experienced care professionals at Grace Pointe will assess your loved ones individual needs and recommend the most appropriate level of care. We believe in personalized care plans to ensure your loved one receives the best possible care.What is the cost of long-term senior care at Grace Pointe, and how can I afford it?The cost of long-term senior care varies depending on the level of care and services required. Grace Pointe offers a continuum of care approach, ensuring you only pay for the care your loved one needs. We will work with you to explore financing options, including community resources for Medicaid and Veterans benefits, to make care more affordable.Can I visit my loved one in long-term senior care at Grace Pointe of Greeley?Yes, we encourage family visits and understand the importance of staying connected. We also encourage you to enjoy activities and events to see the life of Grace Pointe experienced by your family members. There are some guidelines for visiting after hours to ensure the safety and comfort of the Grace Pointe residents, which can be discussed with our staff.How can I learn more about Grace Pointes long-term senior care options?You can explore more details about our long-term senior care services on our Long-Term Care Services page. Feel free to contact our team for specific information and to request a tour.How can Grace Pointe of Greeley help ensure that I dont pay for services my loved one doesnt need in the long term?At Grace Pointe, we understand the importance of affordability in long-term senior care. We offer a continuum of care approach, which means we tailor care plans to your loved ones specific needs. By doing so, we ensure that you only pay for the necessary services, maximizing affordability while maintaining high-quality care. Can I modify my loved ones care plan if their needs change over time?Yes, we understand that care needs can change. At Grace Pointe, we regularly review care plans and adjust them to accommodate changing requirements to ensure your loved one receives the best care.For answers to common questions about long-term senior care and all our services, visit our FAQ page.Dont let financial concerns hold you back from providing the best care for your aging parents. Grace Pointe of Greeley is here to support you every step of the way. Reach out to our care team with any other questions you may have about your familys care.
It is very easy with everything that is going on in our country and our world right now, to be concerned about the pandemic and start to think about your own mortality and planning. While we recommend planning at all times to always be prepared ahead of time, this certainly provides a reminder for us to stop and take a look at our current situation to make sure that we have at least our basics in place. Powers of AttorneyEach person should have a financial power of attorney that authorizes another individual to make financial decisions on their behalf in case they cannot. They could be unable to because of an illness or an incapacitation or simply just not in town, or maybe they are traveling out of the country. We cannot stress the importance of having a financial power of attorney in place to avoid the necessity for guardianship. We have discussed in detail in other blogs and articles about powers of attorney and guardianships, and we would encourage you to please take a further look at those, and why it would become important to have a financial power of attorney in place.A medical power of attorney is an essential document that authorizes another individual to make medical decisions on your behalf if you are not capable or able to make those medical decisions for yourself. Although there is a healthcare statute in the state of Pennsylvania that will name the next of kin to be able to make those healthcare decisions in case you cannot, we stress the importance enough of having this document in place to ensure that the people that you want making those decisions can make them without unintended people being named as well. When you reach the end-of-life stage it's also important that you have in place a living will. If the living will is coupled in one single document with a medical power of attorney, that is also considered an advanced healthcare directive. We recommend having these documents in place to ease the burden on your family. This will save them from having to make those end-of-life decisions if two qualified physicians put in writing that there is no realistic hope of recovery that you will always remain end-stage medical or vegetative, comatose, permanently unconscious, or terminally ill. There is certainly a lot that goes into the medical definition, but plainly stated, it is imperative to decide for yourself how you would like those decisions to be made rather than to put the burden on a loved one to feel like they have to play God or pull the plug on their family member. Review Your Current Documents, Including Beneficiaries, to Ensure They Meet Your Needs and Desires We encourage anyone who has planning in place to not assume that it is up to date or that it is what their current wishes are, things change over time. It is also important to review all of your beneficiary designations on accounts, such as life insurance policies, annuities, retirement accounts, etc. Often, the most overlooked item is reviewing the beneficiary designations of an account, and it is probably the most critical thing that can screw up an estate plan. Please make it a priority to review your documents to make sure they accurately reflect your wishes. If you have questions or need to make some changes we would be more than happy to see you at one of our workshops to discuss the different documents and how they can assist you and your family. We certainly understand if there is any anxiety or stress that you are experiencing but encourage you to be prepared no matter what, which will give you a sense of comfort and security. If you would like further information about this topic or to learn more about our firm, please visit us at www.bellomoassociates.com or call the office at 717-845-5390.
Finding a home care service for yourself or an aging loved one is one of the most important decisions you can make. Over three-quarters of adults want to age in place, and you want to ensure that youre receiving the highest level of care. But in this time of transition, one aspect of the senior care search tends to weigh heavy: the cost.At ComForCare, we understand that financing care is one of the most pressing concerns families have during this process. Thats why weve created this guide with several frequently asked questions about affording in-home care. What In-Home Care Services Does Medicare Cover?Medicare eligibility can be quite limited when it comes to home health services. Part-time or intermittent home health aide services are listed as eligible home health services. However, you must meet all of these criteria to qualify:You are under a doctor's care, and care services are created and reviewed regularly by that doctor.A doctor must certify that you need:Intermittent skilled nursing care other than drawing blood, ORPhysical therapy, speech-language pathology, or continued occupational therapy services.You must be homebound.Of course, not all seniors who need a helping hand also need skilled nursing care. Thats where home care services come in. We can assist with daily living activities for seniors who need it, even if they arent homebound or need regular at-home medical care.What is Skilled Nursing Care and How is it Different from Home Care?Home care services like ComForCare help with eating, dressing, personal hygiene, shopping, cleaning, and more. The care is non-medical and intended for older adults who need a helping hand around the house for their safety.Skilled nursing care can provide these services as well, but the key difference is that medical care is also involved. A doctor can prescribe home health care and determine if you or your loved one requires such services.Does Medicare Reimburse Home Care Service Provided by Family Members?Medicare does not cover any care unless it is provided by a licensed caregiver. Thats part of what makes finding a home care provider an appealing option. Taking care of someoneeven someone you loveis labor for which you dont receive compensation without certification. While paying for home care may seem intimidating, it can save you a great deal in the long run. Heres How:Decreased chance for your loved one to experience falls or condition complications, preventing hospital expenses and pain.Decreased need to take PTO or leave work to provide care. Fewer costs related to your own health and stress levels.Is Home Care Affordable Compared to Other Senior Care Services?Believe it or not, home care tends to be the least expensive senior care option available. According to the Genworth Cost of Care Survey, the average national cost of a private room in a nursing home was an astronomical $108,405 in 2021. Assisted living facility costs, meanwhile, came in at an average of $54,000 for the same year. While home care costs vary depending on the persons specific needs, they typically fall below these numbers. Plus, you get the advantage of receiving high-quality care in the comfort and dignity of your own homenot competing for space in a basic or shared facility room.How Can I Get Help Paying for In-Home Care Services?Financing home care for yourself or a loved one can, understandably, feel impossible at first. If so, youre not aloneup to 41% of Americans over 50 dont believe that they will be able to stay in their current home and community. But at ComForCare, we hope to change that.We offer flexible home care options, from full-time to part-time care. Our caregivers can start by filling in gaps when family members are handling other obligations like work. If your familys needs change, we can always work with you to change the schedule. Were also happy to share resources for financing care, which may include:Veterans benefitsLong-term insuranceWorkers compensation Life insuranceReverse mortgage or home equity loansAnnuities, investments, and savingsBottom Line: Home Care is a More Realistic Option Than You Think!Respecting the wishes of your loved ones isnt impossible. At ComForCare, we work with each family to create a top-quality home care plan that wont cause an undue financial burden. Even if youre just beginning your journey to in-home care, call us at (800) 886-4044 today to ask us anything, 24/7. Were ready to help you find the perfect caregiver!
Our Firm Prepares You for Life What makes our firm different is that we were built with the needs of growing families in mind. We understand you are BUSY, you are growing, you are planning for a life of prosperity and you value ease, convenience and efficiency. You are raising children, and caring for elderly parents, while also working hard to build your own nest egg for a lifetime of support. You want to know youve made the best decisions for your family and that your plan will work when your loved ones need it most. You want to make sure your minor children would be raised by the people you choose, and never by anyone you wouldnt want, and that your teens and adult children are properly prepared to care for you and what you leave behind. You want to feel confident that youve made the right choices, and handled everything so that you arent leaving behind a mess, when something happens. That is our focus as well. Weve developed unique systems to give you the same access to a Personal Family Lawyer as was previously only available to the super-wealthy, so you can have the guidance you need to build and maintain a life of prosperity and wealth. And, to keep your family out of court and out of conflict, which is the greatest risk to the people you love and all you have created, even if youve already worked with a traditional lawyer or created documents online. Our Team Is Here for You We encourage communication with our clients. In fact, weve thrown out the time clocks so you never have to be afraid to call with a quick question. Everything we do is billed on a flat-fee basis, agreed to in advance, so there are never any surprises. We have a whole team to serve you. When you call our office to ask your quick question, you wont have to wait hours or days for a phone call back. Youll get your question answered, right away. And, if you need to schedule a more in-depth legal or strategic call with your Personal Family Lawyer, a call will be scheduled when you're both available and ready for the call so we can make the very best use of your time and not waste your time by leaving voicemail after voicemail back and forth. And, we ensure the most important details of your planning are followed through on and your plan continues to work throughout your lifetime. We have a funding coordinator to ensure your assets are owned the right way throughout your lifetime and none of your assets will end up going through a long, expensive court process or being lost to the state because they were missed after your death. Weve created unique membership programs to keep your plan up to date year in and year out as well as give you access to our Trusted Team of Legal Experts for guidance on ANY legal or financial matter. One day you will need a lawyer. I dont know why and I dont know when, but when you do, you will be grateful you can call on us and well be here to advise you or get you out of a jam. We Help You Transfer Your Life and Legacy Lastly, we believe your financial wealth is only a small part of your overall Life and Legacy Planning which is made up of your far more valuable and most often lost upon incapacity or death intellectual, spiritual and human assets. These assets are what make you who you are, and sum up whats most important to you. And, a survey of inheritors has revealed that what they care about even more than inheriting your money, is inheriting these intangible assets. Most estate plans only focus on the transfer of your financial wealth to the next generation. Most people have such great intentions of passing on the intangible, but very few ever get around to it. Its just not a priority, until its too late. How much do you know about your grandparents values? Their most prized personal possessions? How they felt about you? What they had learned during their lifetime? If you are like most people, you know very little. Thats why we build the capture and passage of these most valuable assets into every estate plan we create. Not only will we help you pass on your money, but also your values, your insights, your stories and your experience the truly valuable assets your loved ones care about the most. Weve developed a tool that allows us to capture and pass on your whole family wealth, including your Intellectual, Spiritual and Human assets. I cant go into all of the details here, but well definitely talk about it when you come in for your Life and Legacy Planning Session.