Medicare Secondary Payer Requirements

The Centers for Medicare and Medicaid Services uses the term "Medicare Secondary Payer" to indicate that Medicare pays health care claims after a third-party payer contributes first. It applies to claims for which Medicare is not responsible for paying first. Medicare Secondary Payer status aims to shift costs from Medicare to private sources whenever possible and appropriate.

Employed Elderly

• If you are 65 or older and employed by an employer with at least 20 employees or are married to a spouse of any age under the same conditions, Medicare benefits become secondary to the group health plan provided by your employer or your spouse's employer. You have the right to refuse these benefits and have Medicare coverage only.

End-Stage Renal Disease

• Anyone who becomes eligible for Medicare because of end-stage renal disease but who already has had group health plan insurance for up to 30 months from the date of Medicare eligibility falls under Medicare Secondary Payer rules. That applies as long as Medicare was not already the primary payer due to age or disability.

Workers' Compensation

• When you have workers' compensation or black lung benefits, Medicare is secondary payer. Individuals have the responsibility of seeking payment from workers' compensation whenever payment can be reasonably expected under that system.

Liability and No-Fault Insurance

• Medicare is secondary payer to any no-fault insurance (such as no-fault automobile insurance) and any liability insurance (such as malpractice insurance). MedPay qualifies as a form of no-fault insurance.