Consequences of Not Using a Medicare Set-Aside Account

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May 16, 2023

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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.



Why You Should Create an MSA Account

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.



Keep Your Medicare Coverage

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.



Stay Eligible for Public Benefits Programs With Asset Limits

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.



Avoid Liability After a Workers Compensation Settlement

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.



Consult With a Special Needs Planning Attorney

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.



Learn More About MSAs

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.

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speech-language services for individuals with Parkinson's disease and other neurological disorders.Parkinson's DiseaseParkinson's disease may affect voice volume, speech clarity, and swallowing.Treatment may involve exercises and strategies designed to support communication and functional abilities.Mind2Mouth offers the SPEAK OUT! program for appropriate individuals with Parkinson's disease.Brain InjuryBrain injuries may affect communication, attention, memory, and organization.Therapy may focus on functional communication and strategies for everyday activities.Other Neurological ConditionsSome neurological disorders affect speech coordination, cognitive communication, or swallowing.A professional evaluation helps determine whether speech-language rehabilitation is appropriate.Personalized Treatment GoalsEvery person experiences neurological recovery differently.One patient may prioritize speaking more clearly.Another may want to communicate with family members using familiar words and phrases.Someone experiencing swallowing difficulties may need treatment focused on appropriate eating and drinking strategies.Examples of Rehabilitation GoalsThese may include:Expressing basic needsFinding familiar wordsParticipating in conversationsImproving speech clarityUnderstanding instructionsFollowing daily routinesUsing memory strategiesCommunicating during medical appointmentsManaging swallowing difficultiesUsing communication aidsWhy Meaningful Goals MatterRehabilitation should address activities that are important to the patient.A goal involving a favorite hobby, family conversation, or everyday responsibility may be more personally meaningful than an exercise that is unrelated to daily life.Mind2Mouth emphasizes functional treatment based on each individual's needs, interests, and routines.What to Expect During a Speech Rehabilitation EvaluationAn evaluation helps the speech-language pathologist understand the patient's condition, abilities, and treatment priorities.The Initial Assessment May IncludeReview of medical historyDiscussion of the stroke or neurological diagnosisAssessment of speech clarityLanguage evaluationCognitive-communication assessmentSwallowing assessment when indicatedReview of everyday communication concernsDiscussion of treatment goalsDeveloping an Individualized Treatment PlanAfter evaluating the patient, the therapist can recommend an appropriate treatment plan.This may include therapy goals, session frequency, practical exercises, and family education when appropriate.Mind2Mouth states that sessions may last approximately 3045 minutes, although the recommended schedule depends on individual evaluation findings.The Importance of Family InvolvementFamily members can play an important role in rehabilitation after stroke.They often understand the patient's communication habits, interests, and previous abilities.With the patient's permission, relatives may participate in learning strategies that support everyday communication.Helpful Ways Families Can ParticipateAllow additional time for responsesReduce background distractionsAvoid interrupting unnecessarilyUse clear languageConfirm understandingEncourage communication attemptsPractice recommended activitiesRespect the patient's preferencesSupporting Someone With AphasiaA person with aphasia may struggle to express words but still understand the situation.Family members should avoid speaking about the individual as though they are not present.Whenever possible, patients should be included in conversations and decisions.Encouraging Communication Without PressureRecovery may involve good days and difficult days.Families can provide encouragement while recognizing that communication difficulties may cause fatigue or frustration.Therapy strategies should be practiced according to professional recommendations.Emotional Well-Being During Neurological RecoveryCommunication difficulties can affect emotional health.Some stroke survivors feel frustrated when they cannot express themselves as easily as before.Others withdraw from conversations because they worry about being misunderstood.Common Emotional ChallengesThese may include:FrustrationReduced confidenceAnxiety during conversationsSocial withdrawalFear of making mistakesDifficulty adjusting to new limitationsConcern about independenceWhy Social Connection MattersMeaningful relationships remain important even when communication changes.Family conversations, familiar hobbies, and appropriate social activities can help patients stay connected.Persistent depression, anxiety, or significant emotional changes should be discussed with qualified healthcare professionals.Measuring Progress in Speech RehabilitationRecovery is not always predictable.Some individuals make noticeable improvements, while others experience slower changes or continue to need communication strategies.Progress May Be Evaluated ThroughSpeech clarityWord retrievalLanguage comprehensionFunctional communicationAttentionMemory strategiesParticipation in conversationSwallowing functionAbility to use communication aidsWhy Progress Looks Different for EveryoneFactors that may influence recovery include:Type and severity of neurological injuryAreas of the brain affectedPrevious communication abilitiesExisting medical conditionsCognitive functioningFatigueTreatment responseAvailable supportTherapy should focus on realistic improvements rather than guarantee complete recovery.Why Home-Based Rehabilitation Can Be HelpfulFor some older adults, traveling to appointments can be difficult following stroke or neurological illness.Mobility limitations, transportation requirements, and fatigue may create additional challenges.Mind2Mouth's in-home approach allows patients to receive individualized treatment within familiar surroundings.Practical Benefits of Home-Based RehabilitationThese may include:Reduced travel demandsFamiliar communication partnersOpportunities to practice real-life situationsIndividualized treatmentConvenient participation in daily routinesFamily education when appropriateConnecting Therapy With Daily LifeA patient may practice ordering a meal, explaining a need, or participating in a family conversation.These activities can help reinforce communication strategies in meaningful situations.Home-based services do not replace emergency care or medically necessary hospital treatment.They are intended for individuals whose needs are appropriate for this treatment setting.Understanding Referrals and InsuranceBefore starting rehabilitation, families should verify insurance coverage, physician referral requirements, and appointment availability.Mind2Mouth states that a physician prescription or referral is required before beginning speech therapy.Insurance ParticipationThe practice identifies the following insurance arrangements:MedicareHorizon Blue Cross Blue ShieldAetnaCoverage depends on the individual's specific plan, eligibility, benefits, and medical necessity.Some insurance plans may offer out-of-network benefits.Questions Families Should AskIs the provider in network?Does the plan cover in-home speech therapy?Is prior authorization required?Is a physician referral necessary?Are copayments or deductibles involved?How many visits may be covered?Is telepractice covered when appropriate?Current coverage should be verified before beginning treatment.Choosing a Speech Rehabilitation ProviderNot every speech therapy practice focuses on adult neurological rehabilitation.When choosing a provider, families should consider the clinician's experience, treatment approach, and ability to address the patient's needs.Important QuestionsDoes the provider treat adults recovering from stroke?Is aphasia therapy available?Can cognitive-communication concerns be addressed?Are swallowing evaluations and therapy offered?Is treatment provided in the patient's home?How are functional goals established?How is progress reviewed?Can family members participate?What insurance plans are accepted?What documentation is required?Mind2Mouth specializes in adult speech-language therapy with a focus on functional outcomes and individualized care.Expert Tip: Make Communication Goals PersonalStroke Rehabilitation Tip: Before beginning speech-language rehabilitation, identify three everyday situations that have become challenging. These might include speaking with family, explaining symptoms during medical appointments, finding words, or eating safely. Discuss these examples with the therapist so treatment can focus on meaningful daily activities.Small, practical improvements can make a significant difference in confidence and everyday participation.Frequently Asked Questions About Speech Rehabilitation1. Can speech therapy help after a stroke?Yes. Speech-language therapy may help address communication, language, cognitive-communication, and swallowing difficulties following stroke. Treatment depends on professional assessment and individual needs.2. Does Mind2Mouth provide aphasia rehabilitation?Yes. Mind2Mouth offers individualized aphasia therapy for adults experiencing language difficulties after stroke or brain injury.3. Can speech therapy help with swallowing difficulties?Speech-language pathologists can evaluate and treat certain swallowing disorders. Mind2Mouth provides swallowing therapy, including NMES when clinically appropriate.4. Are rehabilitation sessions provided at home?Yes. Mind2Mouth provides personalized, one-on-one speech-language rehabilitation in patients' homes throughout Monmouth County, New Jersey.5. Is a physician referral required?Yes. Mind2Mouth requires a physician prescription or referral before beginning speech therapy. Families should also confirm insurance coverage and current appointment availability.Rebuilding Communication and Confidence After Neurological IllnessA stroke or neurological condition can affect speech, language, memory, attention, and swallowing in ways that influence everyday independence.Although recovery varies, specialized speech-language rehabilitation can help individuals work toward meaningful functional goals.For adults and families throughout Monmouth County, New Jersey, Mind2Mouth Rehabilitation Speech Therapy provides personalized, in-home services focused on communication, cognition, and swallowing.Its treatment approach includes stroke rehabilitation, aphasia therapy, cognitive-communication support, and swallowing therapy.By connecting professional treatment with familiar routines and personal goals, Mind2Mouth helps patients practice skills that matter in their daily lives.Learn More About Mind2Mouth Rehabilitation Speech TherapyLooking for speech and language rehabilitation after stroke or neurological illness in Monmouth County, New Jersey?Visit Mind2Mouth Rehabilitation Speech Therapy on SeniorsBlueBook.com to explore its rehabilitation services listing and learn more about available treatment options.Understanding the available rehabilitation services can help patients and families take informed steps toward improved communication, everyday independence, and quality of life.

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Entrusted Legacy Law

Special Needs Trusts 100 Pinewood Lane Suite #303, Warrendale, Pennsylvania, 15086

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Entrusted Legacy Law

Estate Planning 100 Pinewood Lane Suite #303, Warrendale, Pennsylvania, 15086

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. 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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 at 412-547-9855 to schedule your Life and Legacy Planning Session and take the first step in protecting your family, your assets, and your future.

Entrusted Legacy Law

Elder Law 100 Pinewood Lane Suite #303, Warrendale, Pennsylvania, 15086

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