In determining how to help injured plaintiffs, the ongoing medical coverage and care they need is one of the primary concerns we handle as comprehensive settlement planners.

In figuring out what approach makes sense, attorneys often ask up questions like: 

• Does my client need a special needs trust?
• Do I need to get my client eligible for Medicaid? 
• Should my client enroll in an Affordable Care Act policy?

There is no one-size-fits-all answer. That’s why when we meet with clients we look at a variety of factors, including: 

1. The amount of money that the client is going to receive. 
2. The client’s future medical needs (including injury-related medical care).
3. The client’s future financial needs.

It is important to consider all possible medical health care options in order to best serve your client.

Though the Affordable Care Act is a hotly debated political topic, it is undoubtedly a valuable option that is now available to injured plaintiffs (and an option that was not available when pre-existing conditions were used to determine eligibility for private health insurance coverage).

Why the Affordable Care Act?

The Affordable Care Act can be a viable option for ongoing medical coverage if your client is eligible for a special needs trust, or if they are not eligible for Medicaid. Because there are no eligibility requirements for an Affordable Care Act policy, any client can enroll in one of these plans.

That means nearly all clients, even those who may be catastrophically injured, can get a fairly affordable plan through the Affordable Care Act, either during open enrollment or a special enrollment period. It is one more option that, before the Affordable Care Act, plaintiffs did not have.

Other Benefits of the Affordable Care Act

Under the Affordable Care Act, health insurance policies must cover essential benefits, including (but not limited to): hospitalization, emergency room services, ambulatory services, maternity care, pediatric care, and certain mental health and therapy services.

Other benefits offered by the ACA are:

• Health insurers may not refuse coverage due to pre-existing conditions, nor can they charge higher rates based on medical history.
• ACA has no right to reimbursement, unlike needs-based government benefits like Medicare or Medicaid. Meaning, if ACA cover’s $200,000 in medical expenses due to a personal injury accident, there is no need to reimburse the health insurance company after your case settles.

So, if you are wondering whether it is best to set up a special needs trust to help your client remain on Medicaid, or if your client would benefit from enrolling in an Affordable Care Act type policy, give us a call now. We can help you and your client think through those issues and help advise your client to do the right thing for them and their situation.