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What other medical insurance options are available for my client after he has received a personal injury settlement?

by: Begley Admin

The previous blog discussed the importance of ensuring that plaintiffs in personal injury lawsuits obtain the best possible medical coverage. This blog continues the discussion and focuses on other medical insurance that may be available. This includes:

• Medicare. A person receiving SSDI for two years will receive Medicare. It is important to obtain a Medicare supplement, if at all possible. There is an open enrollment period for Medicare supplements for six months after the Medicare recipient obtains Medicare Part B. Another option is to enroll in a Medicare Advantage Plan. There is an open enrollment period for Medicare Advantage Plans from November 15 through December 31 of each calendar year. During that same time period a beneficiary may switch from Medicare Advantage back to original Medicare. A beneficiary may also switch from one Medicare Advantage plan to another Medicare Advantage plan during that same period of time. During this timeframe there is also open enrollment for Medicare Prescription Drug plans (Part D). Beneficiaries may switch from one Medicare Part D plan to another during this period of time. Be sure that the client is enrolled not only in Medicare Part A but also Medicare Parts B and D.

• Medicaid. An extremely important source of funding for medical needs for persons with disabilities is Medicaid. About 76 percent of persons with disabilities receive their Medicaid through SSI. A person may also be eligible for Medicaid without receiving SSI because of a “spend down”. In some states, there is no spend down due to an income cap. In those states, a Miller type trust can be established to avoid the spend down.

• Medicaid Waiver Programs. Many states have Medicaid Waiver Programs that disability lawyers must be well versed in. These waiver programs cover specific situations, but most provide for significant home care. Many states have Medicaid Waiver Programs for traumatic brain injury that offer services beyond home care. In some states, such as Pennsylvania, a parent can be paid under a waiver program to care for a child with disabilities.

• Workers’ Compensation. If an injury is related to employment, the plaintiff may be entitled to medical coverage under a Workers’ Comp insurance policy or directly from the company. It is often possible to settle a case and retain some coverage through the Workers’ Comp carrier. However, where there is a third party liability claim and a Workers’ Comp claim, it is much easier to settle the Workers’ Comp claim if alternative arrangements can be made for medical coverage.

• Group Health Insurance. In many special needs trust situations, the trust employs one of the parents, usually the mother, to provide services as caregiver. The trustees arrange with a third-party provider to provide payroll services and group health insurance. Both single and family coverage is available and there is no exclusion for persons with preexisting conditions, so the special needs trust beneficiary is included almost immediately.

To learn more, visit the Begley Law Group website at www.begleylawgroup.com.