July
2011
2011
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FROM MY DESK: Trouble in Toyland
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Profiling Medicare vs. Medicaid
Everyone at the table — the claimant, plaintiff and defense counsel, and insurers — has a significant stake in understanding how workers’ comp or liability cases can be impacted by Medicare or Medicaid laws.
Medicaid vs. Medicare: Separating
the Stripes from the Zebra
Medicaid is a needs-based program managed by each state for lower-income people including pregnant women, children, people who are blind or disabled, or people needing nursing home care. Medicaid is often linked to Supplemental Security Income (SSI) benefits, a needs-based income plan.
Medicare is a federal insurance plan financed in part through payroll taxes and managed by the Centers for Medicare and Medicaid Services (CMS). Medicare is for people 65 and over, people of any age with kidney failure or long-term kidney disease, or people who are permanently disabled and can’t work. Medicare is often linked to Social Security Disability Insurance (SSDI), and neither program is needs-based.
For more detailed information, download What is Medicare/Medicaid from Medicare.gov.
Medicaid vs. Medicare: Key Considerations at Settlement
Medicaid benefits are based on an eligibility formula that includes asset and income tests. Settlement proceeds can easily disqualify the recipient from future medical and income benefits (SSI).
Medicare is considered a secondary payer, which means payments are conditional until another party is determined to be the rightful primary payer. At that point, Medicare will likely require reimbursement for payments already made. Additionally, plans should be established to protect Medicare’s interests from any future cost shifting. While the laws governing Medicare reimbursement have been vigorously enforced for workers' compensation settlements, recent legislation requiring detailed settlement reporting carries a strong message that increased scrutiny is around the corner for parties involved in liability settlements as well.
Failure to be mindful of protecting available benefits and considering Medicare's interests puts EVERYONE at risk. The injured party may lose key future protections, lawyers may be exposed to possible malpractice actions, and insurers may face considerable penalties and unexpected costs.
Medicaid vs. Medicare: It's a Jungle Out There -
Let a Settlement Consultant Be Your Guide
Medicaid benefits can be protected by a special needs trust, one tool commonly used to “stretch” settlements for those who qualify. Authorized by Congress specifically for this purpose, the trust is not counted as an asset against the Medicaid formula. Using a structured annuity to fund the trust can also help minimize taxes and maximize long-term benefits and security for the injured party.
Medicare's future interests can be protected in some cases with a Medicare Set-aside (MSA). The MSA details exactly how much money should be set aside from the settlement to reimburse Medicare for payments on future medical expenses. Using a structured annuity to fund these accounts can reduce their cost by as much as 40 percent or more, and may free up the dollars necessary to reach a settlement.
Every settlement is different, of course, each with a unique set of challenges and opportunities. The consultants at Ringler Associates provide much more than structured settlements — they provide solutions. Together with our network of administrative partners, we can help make sure YOUR settlement maximizes benefits, minimizes risk, and stands the test of time. Give us a call — it's In Your Interest.
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Tools You Can Use
Ringler Consultants Team Up with Medicare Experts to Protect Your Interests
No doubt the Feds are turning up the heat in their efforts to collect on monies paid by Medicare for any medical expenses it deems the responsibility of a primary payer. Most notable is 2007 legislation that includes a mandatory reporting requirement affecting every settlement — workers’ compensation and liability — involving a Medicare beneficiary. With civil penalties as steep as $1,000 per claim, per day, for noncompliance, ignoring these regulations can be very expensive.
And that is exactly why we team up with experts in Medicare rules and regulations called allocation administrators. These professionals help alleviate the burden of Medicare compliance by serving as a liaison with federal officials, managing Medicare Set-asides (MSAs) at and after settlement, and staying on top of the constantly changing regulatory landscape surrounding Medicare. Together, we can protect your interests, regardless of where you sit at the settlement table: insurer, third-party administrators, defense and plaintiff attorneys, and their clients.
In addition to Ringler Medicare Solutions, a division of Ringler Associates created solely for this purpose, we work with several other highly reputable and accomplished organizations. Contact us for more information.
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