+- Workers' Compensation Discussion Forums (http://www.workerscompensation.com/forums/general)
+-- Forum: Category (/forumdisplay.php?fid=3)
+--- Forum: Injured Worker Forum (/forumdisplay.php?fid=4)
+--- Thread: ? about medicare set aside (/showthread.php?tid=4906)
? about medicare set aside - maw19531 - 07-01-2008 03:51 PM
I am in the process of having my work comp case settled. My attorney has been talking directly with the insurance company. They told him not to talk to their attorney but call them direct. He told me they are close to reaching a settlement. Anyway my case will include a medicare set aside. I am using about $1500.00 per month in drugs. Does anyone know if the insurance company has to reserve enough money for drugs for the rest of my life expectancy which is 27.4 years according to Table 1. Or does CMS work out a settlement with them and once the money is used up then medicare will pay for my drugs. My attorney asked me today if I had drug coverage with medicare and I told him yes but I have to pay 60.00 for a 90 day supply and once I reach the maximum I pay 100% up to the limit. So with a medicare set aside how would that work. I thought work comp would have to pay for my drugs for the rest of my life or am I wrong?
RE: ? about medicare set aside - sparkey - 07-01-2008 04:59 PM
Right now I am going to court to fight the WC insurance co. on paying for my medication. They are saying that I do not need medication for my condition. This may very well come into play in your case and the best thing to do is make sure that your doctor writes that the meds. that you take are needed for your care.
I fought at the last minute to get a letter from my doctor for them to continue. I am sure they will still put up a arguement at the hearing and I will end up paying for them myself through my own insurance co.
RE: ? about medicare set aside - Bad Boy Bad Boy - 07-01-2008 05:16 PM
If in stages of settlement and Medicare Set-Aside Funds, the course you take now, is to make sure your Attorney has your best interest in mind.
Other than saying any more, it wouldn't matter, for your hands are in the hands of your own Attorney. If you feel something isn't right, or worried about something, you best speak to your Attorney now, and get it straight before they present something you wish they hadn't.
RE: ? about medicare set aside - 1171 - 07-01-2008 07:46 PM
without knowing your state it's unknown as to what the comp laws are regarding your future medical care.
you should put your state in your profile.
CMS decides how much is needed for the trust and works it out with the carrier. many times a life care planner has to be hired to work out the medical estimate.
once the future medical is bought out from the carrier the future cost is paid first by the trust then if it's expended by medicare itself.
RE: ? about medicare set aside - capricorn - 07-02-2008 07:25 AM
maw...my husband is in the process settling his medical . His case was settled almost 2 years ago with medical for life. The figures the CMS sent him and the way it is explained, our understanding is that all medical that pertains to his injury is to be paid from this acount once it's established and when the money alloted for each year is gone , medicare will start to pay. I agree with BB. Speak to your attorney and have him clarify it. I'm not sure if it's the same for all.
CAP
RE: ? about medicare set aside - Timothy Belt - 07-02-2008 09:44 AM
You should also keep in mind that Medicare and WC are not equal coverage. I can't speak for all states, but at least in PA WC has no co-pay and basically covers all reasonable, necessary and causally related medical expenses. Medicare on the other hand requires co-pay and does not cover all forms of treatment. So, even if you exhaust the set-aside, you may find that you are paying out of pocket for treatment that used to be covered through WC.
RE: ? about medicare set aside - maw19531 - 07-02-2008 12:03 PM
1171 Wrote:without knowing your state it's unknown as to what the comp laws are regarding your future medical care.
you should put your state in your profile.
CMS decides how much is needed for the trust and works it out with the carrier. many times a life care planner has to be hired to work out the medical estimate.
once the future medical is bought out from the carrier the future cost is paid first by the trust then if it's expended by medicare itself.
I have updated my profile and include my state Illinois.
RE: ? about medicare set aside - Bad Boy Bad Boy - 07-02-2008 12:19 PM
MAW, I'm in (Illinois) also. I'm recently going through the same things. Been trying to settle my cases. Just so you know now, CMS could take up as long as 6 months. But could also be a very short period also. You should be advised about Annuities, Interest Bearing Checking Accounts, and so on. Even Proper spending of Funds before you even do settle. My Attorney has been working with me on that for years now. As I had said up above, make sure your Attorney has your best interest in mind. A good Attorney will help you out with all the issues and concerns I had listed, even how Medical Set-Asides will work for you. You need to obtain full details from your Attorney. Well, I guess I can't say what I had enough. I even repeat it to myself all the time, LOL...
RE: ? about medicare set aside - 1171 - 07-02-2008 12:50 PM
thankx.
I can be more specific in my response if i know the laws involved.
this is a bit old but it's by an Illinois work comp lawyer:
http://www.medicareapproval.com/PCBA%201-13-06%20Medicare%20Update.pdf