July 27, 2017

Medicare & Medicaid Recipients

When the complexities of social insurance programs such as Medicare and Medicaid are added to the settlement mix, settling a case can become cumbersome. Proceeds from personal physical injury and workers’ comp settlements may cause claimants receiving medical benefits to become ineligible for more public assistance. This is unless you decide to utilize a Structure Settlement in conjunction with a trust to protect eligibility.

In structuring your settlement, we make sure that our clients who currently receive public assistance continue to do so. Claimants who receive a settlement can still be eligible to receive Medicare and Medicaid benefits as well as Supplemental Security Income (SSI) payments. A portion of the settlement funds are used to pay for medical and other expenses not covered by social insurance programs. Some of these expenses may include dental, psychological support services, physical therapy and rehabilitation.

A Medical Disability Trust, or a Special Needs Trust, may also be arranged in order to preserve Medicare and Medicaid benefits. The trust enables the client to benefit from a financially secure lifestyle, as he/she usually has high medical bills that may cause extensive stress and psychological problems. The costs associated with hiring financial planners and fund administrators are also vastly reduced because payments from the trust are guaranteed and, once established, there is not very much necessity for management.

Structured Settlements involving recipients of Medicare and Medicaid should take into account a few very important details.

Firstly, it must be noted that the interests of social insurance programs must be protected with respect to benefits already paid out at the time of settlement. This means that the Structured Settlement must already include these payments made by Medicare and ensure that Medicare is not responsible for payments not included under their coverage. Secondly, funds from the settlement must be used to cover medical expenses of the claimant until they are exhausted; only then will Medicare coverage be available.

The Center for Medicare and Medicaid Services (CMS) administers settlements involving Medicare and Medicaid and they will not recognize settlements that do not protect Medicare’s interests. Any amount allocated in the structure for future medical expenses should be placed in a Medicare Set-Aside (MSA). This account is established as a means to pay for projected future medical expenses that would have otherwise been covered by Medicare.

To learn more about the effects Medicare could have on your Structured Settlement please contact one of our consultants at Vega Settlement Group today.


LPL Financial Representatives offer access to Trust Services through The Private Trust Company N.A., an affiliate of LPL Financial.