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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 412-547-9855 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:
What Is a Medicare Set-Aside and When Do You Need One?
What Happens When You Have a Medicare Set-Aside and Don't Need Treatment?
What Happens If My Medicare Set-Aside Runs Out?
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.
These 4 Simple Actions May Deliver Big Payoffs for Mens HealthIts been 12 months since the last Mens Health Month. Have you seen your doctor?June is a great time to make an appointment for a physical with your primary care provider, and its also an ideal month to educate yourself about some of the issues that impact mens health. For example, did you know that men tend to die five years earlier, on average, than women? Or that men face higher risks for health conditions such as lung cancer, heart disease and HIV? And theyre also at risk for sex-specific cancers, including prostate cancer and testicular cancer (learn about those facts and more via the Office of Disease Prevention and Health Promotion).There are many simple actions men can take to benefit their health, this month and every month. Here are four ways to get started.Tip 1If you dont have a primary care doctor, select one. Establishing a relationship with a doctor is important. That person can help you feel better when youre sick, and they can offer advice on how to feel and stay your healthiest. And yet, according to a survey by the Cleveland Clinic, many men arent taking actions to stay healthy. Nearly two in five Gen Z men dont have a primary care provider (PCP). And when it comes to annual physicals, just 32% of millennials and Gen Z men get them, compared to 61% of Gen X and Baby Boomers. A primary care doctor can test your cholesterol and blood pressure, keep you up-to-date on immunizations and advise you on which screenings you need. A PCP visit is like a one-stop shop for your health!Tip 2If youre worried about your mental health, talk to a professional. Its tough to ask for help, and the statistics show that men, in particular, struggle when it comes to addressing their mental health challenges. According to the Anxiety and Depression Association of America, nearly one in 10 men experience some sort of anxiety or depression, but fewer than half seek treatment. If you find that youre feeling unhappy or irritable, and youre avoiding or not getting pleasure from activities you usually enjoy, talk to your doctor or connect with a therapist and share the way youre feeling. They may be able to help.Tip 3Strengthen your support system. Research shows that social connections are important for your mental and physical health; in fact, people with strong social connections may actually live longer. Prioritize connecting with old friends and open your mind to ways to meet new ones. Itll be good for all involved!Tip 4Practice good health habits. There are everyday actions you can take that are known to be good for your health. Those include regular exercise (aim for 30 minutes of movement, five times a week); eating a healthy diet filled with lean proteins, whole grains and lots of fresh fruits and vegetables; finding outlets to manage your stress, such as yoga or deep breathing; getting enough sleep; quitting tobacco; and moderating how much alcohol you drink (the US guidelines recommend two drinks a day or less for men and one a day or less for women).Making healthy choices isnt hard, but you may need to adjust to some changes in your routine. Before long, those healthy choices may make you feel good enough that you wouldnt want to choose any other way.Contact Blue Cross Blue Shield of Alabama located in Mobile at 251-344-2115.
It sounds like something out of a movie: A wealthy man passes away, leaving behind a historic manor, a million-dollar estate, and two women claiming to be his rightful heir.But this isnt fictionits a real case thats making headlines. And while most of us dont have castles and wine collections to pass on, the lessons from this case apply to everyone.At Bellomo & Associates, we believe estate planning isnt just about moneyits about love, legacy, and protecting the people you care about.The Real-Life Drama UnfoldsJustin Bodle was a successful British TV producer. When he died in 2019, he left behind a fortune worth $29 million. But heres where it gets messy His most recent will, written in 2013, left everything to his estranged wife. Since then, he had a new partner and two additional children but never updated his documents. Now, his partner is fighting for what she believes is fair under inheritance laws, while the wife (also the executor) claims the estate is drained by debts and taxes. Its ugly. And preventable. What Went Wrong?His will didnt reflect his current family life.There was no plan to care for the partner or new children.There wasnt enough liquidity to handle taxes and expenses.The result? A bitter court battle, expensive legal fees, and uncertainty for everyone left behind.What Does This Have to Do with You?Even if you dont own a manor in the English countryside, heres what you can learn:Update your plan after life changes. Divorce, remarriage, new kidsit all matters.Be specific. If you want to provide for a partner or child, spell it out clearly.Dont rely on good intentions. Executors have legal duties, not emotional ones.Think about cash flow. Your loved ones will need money to settle your affairs.Get help from a pro. Estate planning is not a DIY project, especially in blended families.Your Legacy Should Be Love, Not LitigationStories like this make headlines because theyre dramatic, but behind every court battle is a family thats hurting. You can avoid that. Lets build a plan that reflects your real life, real values, and real wishesso your loved ones are taken care of and stay out of court.
Understanding the financial aspects of home care is crucial for many families. Its about knowing your options, who to talk to, and where to begin. At Amazing Care, were here to help you navigate through the maze of home care payment options, ensuring you make informed decisions regarding paying for home care services.Home care, an essential service for many, can sometimes be a financial burden. However, with the right information and resources, you can find ways to manage these costs effectively. Amazing Care offers several payment options to alleviate this burden.Medicaid: A viable option for those who meet certain income and health requirements. Amazing Care accepts Medicaid for qualifying services, providing a lifeline for many in need of home care without the financial means to afford it out-of-pocket. For more detailed information on how you can utilize Medicaid for services at Amazing Care, visit our Medicaid payment options page.Medicare: Typically, Medicare covers medically necessary home health care services. If you or your loved one is a Medicare beneficiary, you might be eligible for coverage of Amazing Cares services. This includes nursing care, physical therapy, and more under certain conditions outlined by Medicare guidelines. To understand how Medicare can help cover your home care needs with Amazing Care, check out Amazing Cares Medicare guide.Private Insurance: Home care covered by insurance is available, and many private health insurance policies include home care services. Coverage details can vary widely, so its essential to contact your insurance provider to understand the specifics of your policy. Amazing Care works with numerous private insurance plans, assisting you in maximizing your benefits. For insights on navigating private insurance with Amazing Care, visit our private insurance payment options page.Starting this journey can be overwhelming, but youre not alone. The first step is to contact Amazing Care to discuss your needs and payment options. Our team is dedicated to guiding you through the process, ensuring you access the care you need without undue financial stress. By exploring Medicaid, Medicare, and private insurance options, youll find a path to covering the costs of home care. Questions, please contact us at 303-755-3170.
Comprehensive Special Needs Estate Planning & Special Needs Trusts in PennsylvaniaEstate planning for families with special needs children presents a unique set of financial, legal, and healthcare challenges that require the expertise of a special needs planning attorney. Not all estate planning lawyers understand the intricacies involved, but the experienced special needs estate planning attorneys at Entrusted Legacy Law are dedicated to ensuring your child with special needs is fully protected when you are no longer able to serve as their primary caregiver.We provide a full range of estate planning services tailored to families with special needs children in Pennsylvania. Our goal is to help you preserve assets for your childs future care while ensuring they remain eligible for essential government benefits like Medicaid and Supplemental Security Income (SSI). We assist in setting up special needs trusts (SNTs) to safeguard financial resources, appointing legal guardians and trustees, and identifying long-term care options to ensure your child receives the best possible support and housing solutions.Special Needs Trusts & Asset ProtectionOne of the most significant challenges in special needs financial planning is ensuring that your child has adequate resources without jeopardizing their eligibility for public assistance programs. Many families unknowingly risk disqualifying their child from essential benefits by leaving them a direct financial inheritance. Instead, the best strategy is to establish a special needs trust to provide financial security while preserving their access to Medicaid, SSI, and other government assistance programs.A properly structured special needs trust allows funds to be used for supplemental expensessuch as medical care, therapy, education, and personal carewithout affecting eligibility for disability benefits. However, the regulations governing these trusts are complex. Funds must be managed by a designated trustee and cannot be distributed directly to the beneficiary, as this could trigger disqualification from public benefits. Additionally, a child's needs evolve over time, making it critical to have a trust that can adapt to changing circumstances and legal requirements.By working with an experienced Pennsylvania special needs attorney, you can ensure that your childs special needs trust is legally sound, structured correctly, and customized to their specific requirements.Special Needs Planning for Families in PennsylvaniaAt Entrusted Legacy Law, we specialize in estate planning for children with disabilities, including Down syndrome, autism, cerebral palsy, and other developmental or intellectual disabilities. Our firm helps families create a comprehensive life care plan that provides financial security while safeguarding access to government benefits and essential support services.Whether you need help establishing a special needs trust, securing a legal guardian, or planning for long-term care and housing, our Pennsylvania special needs planning attorneys are here to guide you through every step of the process.Contact Entrusted Legacy Law today to start creating a sustainable, secure future for your child with special needs.
Estate Planning for Everyone You Love and Everything You OwnHave you ever considered what would happenlegally and financiallyto you, your family, your assets, and everything you care about if the unexpected were to occur?If your estate plan is outdated or non-existent, your assets could be lost to the State Department of Unclaimed Property, subjected to an expensive and time-consuming probate process, or even end up in the wrong hands. Without a comprehensive estate plan, your loved ones may face unnecessary financial hardship, legal disputes, or court intervention at a time when they need certainty and protection the most.If you dont know exactly what would happen to everything you own and everyone you love, the first step is to gain clarity. You need to understand how your current estate plan (or lack thereof) will impact your family so you can make informed decisions about whether it truly aligns with your wishes.How Entrusted Legacy Law Helps You With Estate PlanningWe offer customized estate planning solutions designed to protect your family, preserve your wealth, and ensure your wishes are honored. Through our Life and Legacy Planning Session, we take the time to educate you on the legal, financial, and personal implications of your estate choices.Step 1: The Life and Legacy Inventory & AssessmentBefore your Life and Legacy Planning Session, you will complete a comprehensive estate inventory that outlines your financial assets, real estate holdings, retirement accounts, life insurance policies, and other valuable property. This step ensures that we have a full picture of your estate and can identify potential gaps in your asset protection strategy.Step 2: Creating a Personalized Estate PlanIf you decide that your current estate plan is inadequateor if you dont have one at allwe will work together to design a legally sound and strategically structured estate plan that meets your familys unique needs. The foundation of your estate plan will often include a revocable living trust, which allows you to transfer your assets into the trust while maintaining control during your lifetime.Benefits of a Revocable Living Trust: Avoid Probate Prevents the time-consuming and expensive court process that could otherwise delay asset distribution. Minimize Estate Taxes Helps reduce tax liabilities and protect your wealth for future generations. Ensure Privacy Unlike a will, which becomes public record, a trust ensures your estate remains private. Maintain Control Dictate how and when your assets are distributed to your heirs.For families with complex financial portfolios, business ownership, or special circumstances (such as blended families or special needs children), we offer advanced estate planning strategies tailored to your specific goals.Can You DIY Your Estate Plan?Many people wonder if they can create an estate plan using online templates or generic legal services. Unfortunately, most DIY estate plans fail when families need them the most. What often passes for "estate planning" is nothing more than basic document generation, where you answer a few questions and receive a generic template that may not fully protect your assets or your loved ones. No Personalization A generic template cannot address your unique family dynamics, financial situation, or specific legal concerns. Legal Loopholes Improperly structured wills or trusts may be contested in court, leaving your family in legal disputes. No Ongoing Maintenance Estate laws change, and without updates, your plan may become outdated and ineffective.At Entrusted Legacy Law, we dont just draft documentswe provide comprehensive estate planning services that ensure your estate plan actually works when it matters most. We take the time to understand your familys needs, educate you on your options, and create a legally enforceable, tax-efficient, and conflict-free estate plan that gives you peace of mind.Protecting Families & Minor Children Through Estate PlanningIf you are a parent with young children, your estate plan should begin with a solid foundation that ensures your children will always be taken care of, no matter what happens. Without the proper legal protections in place, your children could end up in the custody of someone you wouldnt have chosenor worse, under state guardianship.At Entrusted Legacy Law, we specialize in estate planning for families with minor children. We help parents:Name Legal Guardians Ensure your children are raised by trusted individuals of your choosing.Set Up Trusts for Minor Children Prevent financial mismanagement by appointing a responsible trustee to oversee assets.Establish Emergency Plans Provide clear instructions for immediate care in case of sudden incapacity or death.Whether youre planning for minor children, adult dependents, elderly parents, or a complex estate, we can guide you through the estate planning process with personalized strategies to protect your familys future.Secure Your Legacy With Entrusted Legacy LawEstate planning isnt just about who gets whatits about ensuring that your loved ones are financially secure, legally protected, and prepared for the future.If you want to create a comprehensive estate plan that reflects your wishes, avoids probate, minimizes taxes, and keeps your loved ones out of court and out of conflict, then now is the time to take action Contact Entrusted Legacy Law today to schedule your Life and Legacy Planning Session and take the first step in protecting your family, your assets, and your future.
Pennsylvania Probate: What You Need to Know After the Passing of a Loved OneIf you are here to learn about Pennsylvania probate laws after the passing of a loved one, we first want to extend our sincere condolences. We understand that this is a difficult time, and we hope the information on this page provides clarity and helps minimize the legal and administrative challenges you may otherwise face.What Is Probate in Pennsylvania?Probate in Pennsylvania is a court-supervised legal process that ensures the transfer of assets from a deceased individual to their rightful heirs or beneficiaries. This process is essential for: Proving the validity of a will Appointing an executor (if there is a will) or an administrator (if there is no will) Inventorying and appraising estate property Paying outstanding debts, estate taxes, and creditors Distributing assets as directed by the willor by Pennsylvania intestacy laws if no will existsIn Pennsylvania, if a deceased person owned real estate or assets solely in their name, their estate must go through probate before assets can be legally distributed.The Downsides of Pennsylvania Probateand What You Can Do NextMany residents in Allegheny County, Butler County, Beaver County, Washington County, and Westmoreland County have heard that probate is a lengthy, expensive, and public process. Unfortunately, this is truewithout proper estate planning, probate can be costly and time-consuming.The best way to avoid probate in Pennsylvania is to plan ahead using strategies such as revocable living trusts, beneficiary designations, and joint ownership structures. However, if you are already in a position where probate is required, the best thing you can do is educate yourself and seek experienced probate legal assistance to complete the process as efficiently and cost-effectively as possible.How Is a Probate Case Started in Pennsylvania?Probate can be initiated by any beneficiary or creditor, but most often, the process begins when the Executor named in the will files the original will and a petition with the Pennsylvania probate court.If there is no will, a close relative of the deceased (such as a spouse, child, or sibling) typically files the petition to become the Administrator of the Estate.Choosing the Executor for a Pennsylvania EstateIf a valid will exists, the individual named as Executor will handle the probate processif they are eligible and willingIf no Executor is available or no will exists, any interested party (such as a family member) can petition the Pennsylvania Orphans' Court to be appointed as the Administrator of the Estate.Executor Compensation in PennsylvaniaUnder Pennsylvania probate law, Executors and Administrators receive compensation based on a percentage of the total probate estate value. This is designed to fairly compensate them for their time and effort in managing estate matters.However, Executors can be held personally liable for any mistakes made during the process. Given the complexity of Pennsylvania probate rules, its critical to work with a skilled probate attorney to avoid legal pitfalls.Do You Need to Go Through Probate If a Trust Exists?In most cases, no. If the deceaseds assets were properly titled in the name of a trust, probate is not required. Instead, the successor trustee will work with an estate planning lawyer to administer the trust and distribute assets.However, many families are surprised to learn that simply having a trust does not guarantee that probate will be avoided. Common mistakes include: The trust was not updated over time to reflect new assets. The decedents assets were never properly transferred into the trust.To ensure your estate plan works as intended, its important to work with an estate planning attorney who provides ongoing trust maintenance and reviews.Which Assets Are Subject to Probate in Pennsylvania?Assets that must go through probate include: Real estate, bank accounts, or investments owned solely in the deceaseds name Personal property and valuable assets without a beneficiary designationAssets that bypass probate include: Jointly owned property with Right of Survivorship Bank accounts or investment accounts with Transfer on Death (TOD) or Payable on Death (POD) designations Life insurance policies and retirement accounts with named beneficiariesHowever, some assets that normally bypass probate can still become subject to the process under certain circumstances. Consult with a Pennsylvania probate attorney to determine if probate applies to your specific situation.How Pennsylvania Intestacy Laws Distribute an Estate When There Is No WillIf no valid will exists, Pennsylvania intestacy laws dictate how the estate will be distributed:1 Spouse (If married, a portion or all of the estate goes to the spouse)2 Children (If the deceased had children, they inherit next)3 Parents (If there are no children, parents inherit)4 Siblings (If no spouse, children, or parents, siblings inherit)This highlights the importance of estate planningwithout a will or trust, the state determines who receives your assets.How Long Does Pennsylvania Probate Take?The timeline for Pennsylvania probate varies depending on the estates complexity. On average: Minimum of 12 months for simple cases Up to 2+ years for complex estates, disputes, or tax-related mattersWhat Are the Costs of Probate in Pennsylvania?Probate costs in Pennsylvania include: Attorneys fees (Based on estate size and complexity) Court filing fees Executor fees (set by Pennsylvania law) Appraisal and valuation fees Publication and administrative costsIn more complex estates, additional fees may apply, increasing probate expenses and delays.How to Choose the Right Pennsylvania Probate AttorneySelecting the right probate lawyer in Pennsylvania is crucial. Many general practice lawyers dabble in probate law, but only experienced probate attorneys have the knowledge to navigate complex estate matters efficiently. You do NOT have to use the attorney who prepared the will. You have the right to choose a specialized probate lawyer who understands the nuances of Pennsylvania estate law and can expedite the process. Avoid costly mistakes. Working with an experienced probate attorney prevents errors that could increase costs, cause delays, or result in legal disputes.Contact Entrusted Legacy Law for a Complimentary Pennsylvania Probate ConsultationIf youre ready to begin the probate process in Pennsylvania, our Allegheny County and Butler County probate attorneys are here to guide you.Call us at 412-347-1731 to schedule a complimentary 15-minute consultation to determine your next best steps.During your consultation, we will: Answer your probate-related questions Provide guidance on estate administration Help you navigate the Pennsylvania probate process efficientlyWe are here to relieve the legal and administrative burden during this difficult time and ensure that your loved ones estate is handled with care.