Does Your Client Have A Plan For The Future?

Does Your Client Have A Plan For The Future?

The ACA Special Enrollment Window Is Opening February 15 Through May 15

***NEWSLETTER***

"This blog post is intended solely for educational and informational purposes and does not constitute legal advice. The content herein should not be relied upon as a substitute for professional legal consultation. Reading this post does not create an attorney-client relationship with The Lien Project, PC or any of its attorneys. For personalized legal guidance, please consult The Lien Project, PC."

If your clients need a plan for future healthcare expenses, the next few months may present an important opportunity. President Biden has signed an Executive Order reopening government health insurance markets for a special enrollment window, offering uninsured Americans additional time to enroll through the ACA exchanges.

The new open enrollment period runs from February 15 to May 15, with coverage beginning immediately under 2021 insurance plans.

On the ACA exchanges, insurance plans are subsidized to be affordable for individuals who expect to earn less than 400% of the federal poverty level in 2021—so long as they earn at least the poverty level. This year, the poverty threshold is $12,760 for an individual, and for a family of four, 400% of the federal poverty level is $104,000.

For those qualifying under this threshold, bronze-level plans are generally covered by subsidies, with the insured responsible only for deductibles and co-pays—which can be steep. However, for 2021, the out-of-pocket limit for marketplace plans is $8,550 for an individual and $17,100 for a family.

While this special enrollment window is designed to extend access to health insurance amid the COVID-19 pandemic, it also presents an important opportunity for uninsured plaintiffs involved in tort claims or those receiving settlement funds to secure coverage.

Settlement Planning & Health Insurance: A Growing Intersection

At The Lien Project, we’re seeing increased value in plaintiff attorneys discussing health insurance options with clients as part of broader settlement planning. Just as clients are routinely counseled about public benefits eligibility (such as special needs trusts) or financial planning (e.g., structuring settlements with tax-free annuities), it’s equally important to explore healthcare coverage strategies for plaintiffs with ongoing or anticipated medical needs.

If a client is uninsured and faces future treatment, they must be presented with all viable options to cover that care. It’s important that clients understand their attorney’s role is to secure compensation from the responsible party, not to provide guidance on how to manage that recovery—but that includes referring the client to trusted professionals in financial and public benefit planning when necessary.

Considerations for Clients on Medi-Cal

When a plaintiff has no health insurance, they may qualify for Medi-Cal. However, if the net settlement disbursement renders the client ineligible for Medi-Cal benefits (i.e., assets exceeding $2,000), attorneys should help ensure the client is aware of their options:

• The client may choose to accept the funds and “spend down” to requalify. In this case, the client should acknowledge the risks as part of the closing paperwork.
• If the settlement is large enough that spending down is impractical, referral to a public benefits planner—for consideration of a special needs trust or other protective planning—is warranted.

Planning for Healthcare Costs Post-Settlement

For uninsured plaintiffs, obtaining health insurance to cover future care can be a smart use of their recovery. With ACA premiums and out-of-pocket maximums clearly defined, a plaintiff can estimate their total annual healthcare exposure and allocate settlement funds accordingly.

This is especially impactful when significant medical care is expected—such as surgery, physical rehabilitation, or ongoing therapies. By setting aside enough to cover premiums, deductibles, and copays, plaintiffs can protect their recovery and choose plans with preferred providers, hospitals, or practice groups.

Timing matters. Enrollment in ACA plans is typically limited to the annual open enrollment period—unless a special window like this one is open. The current window runs from February 15 through May 15.

The Bigger Picture

Plaintiff lawyers are hired to “go get the money from the bad guys.” But once that recovery is secured, it’s crucial to help clients navigate the real-world implications—including healthcare coverage and benefits planning.

Doing this right requires a strong, well-coordinated team—with each professional staying in their lane and providing guidance within their area of expertise.

Explore More Resources with Lien Project Network

For a deeper dive into lien resolution strategies, settlement planning, and reimbursement challenges, explore our educational modules. Lien Project Network serves as a trusted resource for plaintiff attorneys, providing insights on financial planning, public benefits, and structured settlements in the context of lien management.

Need Assistance? Work With The Lien Project, PC

If you need expert legal assistance in navigating lien resolution, reimbursement claims, or settlement planning, our team at The Lien Project, PC is ready to help. As an LPN member, you earn credits that can be applied toward lien reduction and resolution services provided by The Lien Project, PC, allowing you to offset up to $900 per year. Your investment in continuing education through Lien Project Network not only enhances your lien resolution skills but also reduces the cost of engaging legal experts when needed.

Schedule a Consult today to see how we can help maximize your client’s recovery.