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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:
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.
Navigating Medicare: A Comprehensive Information Guide with MediConnectAre you turning 65 soon or approaching eligibility for Medicare? Understanding your healthcare options is crucial for ensuring you receive the coverage you need. With Medicare being a cornerstone of healthcare for millions of Americans, its essential to familiarize yourself with its information. At MediConnect, our Medicare advisory firm, were here to help you find the plan that works best for you.What is Medicare?Medicare is a federal health insurance program primarily designed for people who are 65 or older. However, it also covers certain younger individuals with disabilities and those with end-stage renal disease. It consists of different parts, each providing coverage for specific services:1. Medicare Part A: Hospital insurance that covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.2. Medicare Part B: Medical insurance that covers outpatient care, doctor visits, preventive services, and some home health care.3. Medicare Part C (Medicare Advantage): A private insurance alternative to Original Medicare (Part A and Part B), often including prescription drug coverage and additional benefits like vision, dental, and wellness programs.4. Medicare Part D: Prescription drug coverage available through private insurance companies approved by Medicare.Understanding EnrollmentEnrolling in Medicare can be a straightforward process if you understand the information for your options and the timing of key decisions: Initial Enrollment Period (IEP): Typically, this is a seven-month period that begins three months before the month you turn 65, includes the month you turn 65, and ends three months after the month you turn 65. General Enrollment Period (GEP): If you missed your Initial Enrollment Period, you can enroll during the General Enrollment Period, which runs from January 1 to March 31 each year. However, late enrollment may result in penalties. Special Enrollment Period (SEP): Some individuals may qualify for a Special Enrollment Period due to specific life events, such as moving, losing employer coverage, or qualifying for additional assistance programs.Making Informed Choices with MediConnectChoosing the right Medicare coverage depends on various factors, including your healthcare needs, budget, and preferences. At MediConnect, our Medicare advisory firm, we take the information you give us to offer personalized guidance and expertise. Helping you make informed decisions: Coverage Needs: Our team will work with you to assess your healthcare needs, including prescription medications, doctor visits, and any specialized care requirements. Costs: Well help you understand the premiums, deductibles, copayments, and coinsurance associated with each Medicare option to determine the total cost of coverage. Provider Networks: Well explain the differences between Original Medicare and Medicare Advantage plans, helping you choose the option that aligns with your provider preferences. Prescription Drug Coverage: Our experts will evaluate your prescription drug needs and compare Part D plans to find the one that best covers your medications at the lowest cost.Additional ResourcesNavigating the complexities of Medicare may seem daunting, but youre not alone. Here are some resources to give you additional information along the way: Medicare.gov: The official Medicare website offers comprehensive information, including plan comparisons, enrollment guidance, and eligibility criteria. State Health Insurance Assistance Programs (SHIPs): These programs provide free, personalized Medicare counseling and assistance to help you understand your options and make informed decisions. Medicare Plan Finder: Use this tool on Medicare.gov to compare Medicare Advantage plans, Part D prescription drug plans, and Medicare Supplement Insurance (Medigap) policies available in your area.As you approach Medicare eligibility, remember that MediConnect is here to support you every step of the way. Our Medicare advisory firm is dedicated to helping you find the coverage that meets your unique needs and preferences.By understanding the various parts of Medicare, enrollment periods, and factors to consider when choosing a plan, you can make confident decisions about your healthcare coverage. Let us guide you through the process and ensure you have the peace of mind that comes with comprehensive Medicare coverage tailored to your individual requirements.
Greetings, I trust this message finds you in good health and high spirits. In my years as an elder law and estate planning attorney here at Bellomo & Associates, Ive had the privilege of guiding families through the intricacies of planning for the future. Today, I want to share some insights on common estate planning mistakes, drawing from the experiences of those Ive had the honor of assisting. Its human nature to postpone tasks, especially those that involve contemplating the future. However, delaying your estate planning can have significant consequences. Whether youre an income-generating couple, a seasoned individual considering nursing home care, or a young family with dreams to protect, procrastination can rob you of the peace of mind that comes with a well-thought-out plan. No two families are the same, and neither should their estate plans be. Cookie-cutter approaches often neglect the nuances that make your situation unique. As your trusted advisor, I emphasize the importance of personalized solutions. Your plan should reflect your values, aspirations, and the legacy you wish to leave behind. Life is dynamic, and so are your circumstances. Marriage, births, career shifts, and even unexpected health challenges can reshape your priorities. Failing to update your estate plan accordingly can lead to unintended consequences. Regular reviews ensure that your plan remains a true reflection of your current life stage and desires. Discussing end-of-life matters can be uncomfortable, but its a crucial step in ensuring your wishes are understood and respected. Communicating openly with your loved ones about your estate plan can prevent misunderstandings and provide clarity during challenging times. In the age of online resources, its tempting to try a do-it-yourself approach to estate planning. However, the potential pitfalls of DIY plans can far outweigh the perceived cost savings. Professional guidance ensures that your plan complies with legal requirements and considers intricate details that may be overlooked. To those of you who resonate with these considerations, I extend an invitation to join us at our next estate planning workshop. Its not just an opportunity to learn about common mistakes but also a chance to connect with others who share similar concerns. Bring your questions, share your stories, and lets navigate the path to a secure future together. Remember, estate planning is not just a legal process; its a journey toward safeguarding what matters most to you. I look forward to meeting you and exploring the important next steps in creating a plan that reflects your unique legacy. To a future of informed decisions and lasting legacies, Jeff BellomoWe offer FREE WORKSHOPS every week! Click here to register!
Im Jeff Bellomo, an elder law and estate planning attorney at Bellomo & Associates in York and Lancaster, PA. Today, were going to explore a topic that resonates with many of you estate planning for blended families. Its a journey that touches the lives of our cherished income-generating couples, our beloved seniors transitioning to skilled nursing facilities, and our forward-looking young families. Lets delve into the intricacies and emotions of Estate Planning for Blended Families. Blended families are born from love that knows no boundaries. When two hearts unite, each with their unique family history and experiences, its a beautiful testament to the power of love and the promise of a new future together. However, it also comes with its set of complexities, especially when it comes to estate planning. Balancing the needs and desires of all family members is a delicate art, one that requires both financial finesse and emotional sensitivity.Estate planning for blended families involves careful consideration of assets, beneficiaries, and distribution. Its not just about dollars and cents; its about protecting the ones you love, no matter their biological or step relationship. One crucial aspect is updating your will to reflect your current situation. Clearly defining how you want your assets distributed and to whom, ensuring that no loved one feels left out or overlooked, is essential. Its about making sure your intentions are crystal clear, and your familys future is secure. Trusts as a Tool for HarmonyTrusts can be an incredible tool for ensuring harmony within your blended family. They offer privacy and efficiency and can be tailored to meet the specific needs of your unique family structure.Consider a trust as a way to protect assets for the benefit of both your spouse and your children. This can be particularly important when there are assets you wish to pass on to your biological children from a previous relationship. A trust can help ensure that your assets are distributed fairly, while also providing for your new spouse. The Importance of CommunicationEstate planning in blended families is not just about legal documents; its also about communication. Open and honest discussions with your spouse and family members can prevent misunderstandings and ensure that everyones concerns are addressed. Remember, an estate plan is not set in stone; it can be adapted and changed as your family dynamics evolve. By fostering an environment of understanding and open dialogue, you can navigate this journey with greater ease. Join Us at Our Estate Planning WorkshopIf youre in a blended family, I invite you to join us at our next estate planning workshop. Its a space to connect with others who face similar challenges and ask questions. Well guide you on critical next steps to create an estate plan that reflects your unique family situation.Together, we can help you build a legacy that ensures the security and harmony of your blended family, allowing your love to shine brightly in the generations to come.
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.