NEW INFORMATION AVAILABLE FROM SOCIAL SECURITY....

[Still in Limbo]

Thanks 1171, I Saved a Copy for Viewing and Info. Later!!

[Sunshine7]

I agree thank you admin.

[freebird]

Here is a question about WCMSA and the IW having private Insurance;

The IW is 50 years old and requires a WCMSA; He is disabled on SSDI and Medicare approved; His WCMSA is $280,000.

This IW has private Insurance thru his wifes employer. He does not take Medicare part B or part D because it would be a waste of money since Medicare part B or part D will not pay because of private Insurance is primary.
This IW was told by CMS to not take out part B or Part D as long as he has Private Insurance. Discussing this with CMS keeps him from having to pay a penalty when he does get on Medicare part B and D.

Now, here is the question. Can/Does the IW use his WCMSA to pay for his work related Injuries OR does the IW have to use his Private Insurance to pay for his work related Injuries?
The IW is Medicare elgible but he does not pay for part B or Part D because of private insurance.

[Bad Boy Bad Boy]

Freebird, I was told something to the fact you talk about.

But, I wanted to be safe or on the safe side. I took Part (B) & then through AARP I took Part (D). Now I had Insurance through the wife's work. What I am allowed to do, was I used the Part (D) till it ran it's course of allowable amount, then switched to her insurance for the remaining part of the year. I never had a problem with Part (D)

Now when a MSA is in place, it also depends on the account, and how it is set-up. Such in my case, I was told it will go into a Interest bearing checking account. I then pay for work related injuries and those medications through that fund. At the end of the year, or when CMS request payment information, you print it out and send it to them, and copies of all related reciepts.

Now this is what I was told.

This 38 page booklet had just come out, because the Commisioners all 50 States, and Attorney's just didn't know all then true in's and out's to what should be proper for a correct issue on setting up a proper MSA. So CMS printed this up, and it is very interesting, and direct.

[1171]

if your private insurance is willing to pay for a settled work injury and they are fully informed I say go for it. at some point in the future you might be able to reduce the amount in the MSA account.

[freebird]

Bad Boy Bad Boy Wrote:Freebird, I was told something to the fact you talk about.

But, I wanted to be safe or on the safe side. I took Part (B) & then through AARP I took Part (D). Now I had Insurance through the wife's work. What I am allowed to do, was I used the Part (D) till it ran it's course of allowable amount, then switched to her insurance for the remaining part of the year. I never had a problem with Part (D)

Now when a MSA is in place, it also depends on the account, and how it is set-up. Such in my case, I was told it will go into a Interest bearing checking account. I then pay for work related injuries and those medications through that fund. At the end of the year, or when CMS request payment information, you print it out and send it to them, and copies of all related reciepts.

Now this is what I was told.

This 38 page booklet had just come out, because the Commisioners all 50 States, and Attorney's just didn't know all then true in's and out's to what should be proper for a correct issue on setting up a proper MSA. So CMS printed this up, and it is very interesting, and direct.

Interesting; I was told by my private insurance that they were primary as long as I was on there plan. They told me not to take out Part B or Part D because it would be a waste of money becuse Medicare will not pay. I called Medicare and they agreed. ALL THIS was before a WCMSA ws part of my future.

I ask this Question in June 2009 to a "expert" Jennifer C Jordan at medval.com

I am a Injured Worker who has been on WC since 2003. Settlement is near. My Question is this;
I am on SSDI and have been Medicare entitled since 2006. I have Medicare Part A only because I am covered under my wives GHP. Medicare agreed with this as did my wives GHP because GHP is primary payer. My GHP has never paid anything for my work related injury so there is no subrogation.
When my Medicare setaside is approved by CMS, I will have funds to set up in a interest bearing account to pay for my monthly Pain Management visits and prescription drugs.
I have talked extensively with my wives GHP and they say I must exhaust the MSA before they will pay. If its is exhausted, then my GHP will kick in and pay whether that be a yearly "shortfall" of funds or the funds are totally exhausted. This is to protect Medicare's Interest.

Here is the answer I received fron Jennifer C Jordan at Medval concerning this;

From: ----------------------------------
Sent: Tuesday, June 23, 2009 1:12 PM
To: Ask Jen(Medval)
Subject: Group Health Policy and Medicare set-asides

The GHP is correct. The order of priority is WC - GHP - Medicare and once settled, it becomes MSA - GHP - Medicare. If at any time you run out of MSA funds pending your next structured settlement check, your GHP benefits will pick up. If your wife is to ever lose her GHP benefits, then Medicare would be the payer and by virtue of its approval of the MSA, the same would apply where Medicare will pay at any time there is a shortfall.

Here is the exact answer that this GHP emailed me;

the question I ask my GHP was;

My husband is going to receive a Medicare Set Aside (MSA) as we have been discussing with the Workman's Compensation Insurance. When this occurs, His case will be closed with Workman's Comp. This is a structured settlement that will release WC insurance company of any future medical expenses - prescriptions, doctor visits, etc., all expenses related to his work injury to his back.

When this is settled and we go back to pain management for his monthly visit, who do we file with for payment? GHP or his Medicare Set Aside (MSA)?

Will we have to exhaust the MSA (Medicare Set Aside) before filing with GHP or will Medicare see United Health Care, the GHP(general health plan), as the primary provider for my husbands work related injury? What about the prescription drugs?

GHP(United Health care) answer was

You should file all claims including prescriptions that are related to his injury should go through the MSA until the funds are exhausted. Once the funds are exhausted, claims go to United Healthcare, then Medicare.
Yes you will have to exhaust the funds before filing with ---, however the non-injury claims should go to UHC then Medicare. Subrogation does not apply in his case because he never used our plan for his injury.

[Bad Boy Bad Boy]

Freebird, yes I agree fully with what you stated. As my wife also had UHC. I think what I was doing, was I was thinking out of the circle (box) so to speak, and looking at the what IF's in the future.

Just so happens, UHC just canceled out our State here in ILLINOIS. I do then think, the what IF's on my part came in handy. Also before this took place, UHC had been swinging the monthly cost up and up & up. So it was becoming so very costly for us. But, if she dumped me from UHC her monthly cost became so much lower, and also helped her employer. So then I picked up Humana Insurance. A simple HMO really cost you nothing. A supplement cost about $278.00 per month if you wish that, & $48.00 for part (D). I tried the supplement, and went back to the HMO plan at no cost to me, picked up Dental at $13.00 per month, and eye care is with Humana. If I looked at the cost figures, we were saving money all the way around.

As you can see, I like to take a good close look at all the possible what IF's. And what if, UHC cut's your State? Will the next Insurance be so easy on you? Kind of like we just never know. That's why I cut out the suprises.

[freebird]

If I lose UHC and the next IC did not accept me or put a rider on my back, I would be forced to take out Medicare part B and Part D. It would be another major challenge in the world of Medical.

Honestly, I would have to drop back and punt.

[Bad Boy Bad Boy]

Well, I hope you wont have to punt.

I'm just way different in thinking is all. I do expect strange things to happen. I like to think ahead some, and think how will I combat the issue before it does happen or take place. This way I'm not so upset if it does happen, yet I have a angle in my back pocket, and ready to use it.

This UHC though has to be costing your wife a good buck out of her check. Or does her employer pick up most of it?

My wife's employer picked up 1/2 or less only.

[freebird]

Her employer picks up 2/3. I think she pays around $140 a month for both of us. It is good Insurance as long as you stay in the PPO.

I do hope that something is done one day where IC's cannot put a rider on individuals because of a past medical issue.