benefits advisory

Ametros provides subject matter expertise and consultation on federal and state benefits for beneficiaries of worker’s compensation and liability settlements. Whether you have a Medicare Set Aside, other medical funds or have a complex settlement that needs full consultation and guidance through the process, we are here to help.

Get a Free Consultation

An Ametros representative will reach out within one business day.

Services We Provide

Often times in complex settlements, a beneficiary, injured party or individual will have the need to retain government benefits, but also concerns about losing them if their case is not handled right. We can help simplify the explanation of what to do. Each case is unique, and we do not apply a cookie cutter approach to our advisory.

Do You Receive:

  • Medicare (Parts A,B, or D)
  • Medicaid
  • Social Security Disability Income(SSDI)
  • Supplemental Security Income (SSI)
  • Veterans Healthcare
  • Veterans Compensation & Disability
  • Medicare Set-Aside (MSA)
  • Medigap
  • Medicare Advantage (also known as Medicare Part C)
  • Consolidated Omnibus Budget Reconciliation Act (COBRA)
  • Institutional Care Program (Long Term Nursing Home Care)
  • Medically Needy Program, MEDS-AD
  • Protected Medicaid
  • Home or Community Based Medicaid Waiver Programs
  • Optional State Supplementation
  • Home Care for Elderly and Disabled (HCE/DA), MRMIP (CA Only).

Already Have a Trust?

Ametros can help with the following services:

  • Bill review and claims processing to make sure the beneficiary is being billed at the correct fee schedule (or better)
  • Access to discount to Provider, durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) and Prescription Drug Networks.
  • Coordination of Benefits – ensure secondary insurance and all entities in the process address their payment obligations properly
  • Compliance reporting. In many cases, disbursement of medical funds must reported to CMS for MSA’s and per MSP regulations. We have both full and self-reporting tools for you

Case Study

Sarah, 38

$435,000 total
$218,000 MSA amount

Situation

Sarah, 38, was receiving a personal injury settlement with a lump sum, an annual annuity, and a MSA for future medical expenses. Ametros’ team became involved due to the various government programs Sarah was receiving to determine how the settlement would impact those benefits.

Initially, our team was advised she was receiving Medicare and SSDI. After additional conversations, it was also determined Sarah was on a Medicaid waiver program, housing assistance, and food assistance.

Actions & Results:

With all of the moving parts, our team was able to coordinate a plan that would protect Sarah’s means-tested benefit eligibility with the use of a special needs trust (SNT), provide her with resources to assist with monthly allowable payments through an ABLE account, and preserve her Medicare eligibility by professionally administering her allocated future medical funds in the MSA.

 

 

Click on the state for links to Medicaid and Benefits website.


It is important to review any eligibility for both entitlement benefits and needs-based benefits. The Ametros team can help you sort through these benefits, and assist with resources to develop a plan to minimize the impact on your benefits from settling your case.


Entitlement benefits include Medicare, Social Security Disability Insurance (SSDI), and Social Security. As a working individual, you pay into these programs through your paychecks so receipt of a settlement will not affect the eligibility for entitlement benefits. However, needs-based benefits, also known as means-tested benefits, include Medicaid, Supplemental Security Income (SSI), food assistance and housing programs. These are based on income and/or asset limits which often vary by state. To remain eligible for these important benefits, it is recommended to have a settlement plan for any funds received so the injured individual will not be disqualified from the program(s).


Nearly every state has a State Health Insurance Assistance Program (SHIP) to help Medicare eligible individuals enroll and customize their care options to what fits their needs best. These centers allow walk-ins, appointments, and over the phone assistance for those eligible for Medicare. They can often assist with other kinds of state aid and eldercare assistance. To find the nearest SHIP click here .


Both Medigap and Medicare Advantage Plans (Medicare Part C) can provide additional and supplemental coverage to traditional Medicare. It is important to note and understand that Medigap and Medicare Advantage are two different kinds of plans and cannot be combined.


Ametros has a family of products available that will not only offer discounts, but also 24/7 support for your coordination of care and reporting to CMS to ensure compliance with your MSA. Contact us to determine which product, CareGuard or Amethyst, is right for you.


Yes, visit your local State Health Insurance Assistance Plan to speak with a Medicare counselor about a Medicare Part D (prescription plan) plan that can help you reduce these costs on your medications. These matters can get complicated and trigger “conditional payments” from Medicare if another insurance plan is supposed to be partially paying for healthcare; however, it does not apply in all cases.


Knowing about SSDI Offsets for MSA’s and other excludable expenses is key to getting this right prior to the finalizing of a settlement. Your SSDI reduction can be minimized or eliminated if the calculations for Average Current Earnings, Excludable Expenses and life expectancy are done correctly. Make sure to ask your advisors about this calculation prior to signing your settlement documents.