The Use of Medicare Set-aside Trusts in Workers’ Compensation Settlements

The Health Care Financing Administration is cracking down on people who owe money to Medicare. They are working with the Department of Justice to go after insurance companies and lawyers who don’t get Medicare’s approval for settlements involving Medicare patients. Medicare can ask for money back if they paid for medical care that should have been covered by someone else, like an insurance company. They can do this before or after a settlement, as long as they get their money back. Medicare’s rules for paying for medical expenses after someone settles a workers’ compensation claim are the same as for personal injury settlements. But with workers’ compensation, Medicare can still pay for medical expenses that come after the settlement, as long as the settlement didn’t allocate enough money for future medical expenses. If that happens, Medicare can figure out how much money should have been set aside for future medical expenses and still pay for them. When you get hurt at work, your employer’s insurance has to pay for your medical bills. If you get a big settlement, some of that money has to be put into a special trust for your future medical expenses. This is to make sure Medicare doesn’t have to pay for your medical care later on. The amount of money in the trust doesn’t have to be exactly what your medical bills will be, but it has to be enough to show that Medicare’s interests have been considered. When someone gets a workers’ compensation settlement, they should make sure to set aside money for future medical expenses in a special trust for Medicare. If they don’t do this, Medicare may refuse to pay for any medical expenses related to their injury after the settlement money runs out. It’s important to work with a lawyer to make sure the settlement is fair and that Medicare will approve the trust before the settlement is finalized. A Medicare set-aside trust needs to be customized for each injured worker. It should not be a one-size-fits-all solution. A proper trust should consider things like Medicaid, taxes, other benefits programs, and where it will be managed. It should also have a plan for what happens if the injured worker passes away.

To figure out how much money to set aside for future medical expenses, the worker’s doctor and their medical history can be used. The proposal for the trust should be detailed and show that it takes care of Medicare’s interests. Every worker’s case is different and needs someone to speak up for them. When asking Medicare for money for medical care, it’s important to tell them all the details about your health, money, and family. The money for future medical care must be put into a special trust. If it’s not done right, you could lose out on other benefits. Each case is different, so the trust and other legal documents need to be carefully written for each person. The people who wrote this are experts in elder law. We want our members to learn about doing their job well and serving the community. We also want to make the way the law works better and learn more about legal studies.

Source: https://www.floridabar.org/the-florida-bar-journal/the-use-of-medicare-set-aside-trusts-in-workers-compensation-settlements/