Medicare payments for medical needs resulting from the negligent acts of others, are generally conditional on future recovery from worker's compensation plans and liability insurers, including self insured companies.  Not only does Medicare have an interest in recovery payments that have already been made when another is liable, but Medicare is becoming increasingly vigilant about preventing the shifting of medical costs onto Medicare when liability is elsewhere.

Medicare has developed rules with respect to worker's compensation settlements and is expected to become more vigilant in liability and negligence cases as well in the near future.

When a case is settled for a client who is either on Medicare or expected to become Medicare eligible within 30 months, there are a number of complex issues that need to be discussed and resolved.

These include the following.

  • Do you need a Medicare Set Aside (MSA) account or trust?
  • Does Medicare have to approve the MSA in advance?
  • What is the proper funding of the MSA?
  • What termination provisions are appropriate in the MSA?
  • Do you need to coordinate benefits with other health plans or with Medicaid?
  • Rule 16 Petitions to Probate Court
  • Qualified Settlement Funds, and other Funding Mechanisms

The development of MSAs over the last ten years suggests that the insurance industry has taken the lead in promoting and determining whether, and to what extent, an MSA is needed and how it should be funded.  This may or may not be in the client's best interest.

Kaye & Associates has experience with MSAs and with both the Medicare and Medicaid programs. Even more importantly, Kaye & Associates works almost exclusively with plaintiffs and plaintiffs' counsel.

Mr. Solem is a member of the Colorado Trial Lawyers Association and with the Elder Law Committee of the Colorado Bar Association.  He and his firm are committed to achieving the best results possible for the injured person and not what may be in the best interest of the defense.  Mr. Solem has over 35 years of experience with Medicare, Medicaid and Social Security and will use his experience and knowledge to get a client through these systems as painlessly and economically as possible.

If you feel confused and stressed out by government programs and regulations, or, if you would like to verify what you are being told by others, Kaye & Associates is always available to discuss the case with you frankly and in confidence.  We handle MSAs, Special Needs Trusts and negotiations of Medicare and Medicaid and insurance liens.  We also act purely as consultants if representation is not needed.