Medicare follows certain health insurance regulations when not the primary provider.
The Centers of Medicare and Medicaid Services follows primary and secondary payer regulations. When Medicare is the secondary payer, it is not obligated to pay for services and items that a primary provider has to fund. The secondary payer regulations protect Medicare from payments outside its responsibility.
Patient Entitlement
For patients entitled to Medicare coverage who are involved in an accident or other incident and do not have no-fault or liability insurance, Medicare has secondary payer obligations. Medicare also falls under secondary payer regulations for patients who have an injury or illness covered under worker's compensation.
30-Month Eligibility
An individual who has a 30-month eligibility or entitlement to receive Medicare coverage and has end-stage renal disease while covered under the Consolidated Omnibus Budget Reconciliation Act (COBRA) continuation health coverage will receive Medicare secondary payer payments. An individual with the condition and under the same 30-month Medicare eligibility or entitlement, yet is under a group health plan, also receives Medicare secondary payer coverage.
Employer Group Health Plan
Individuals who are 65 and older and are covered by a group health plan under a current employer or spouse's employer which has 20 or more employees or is a multi-employer group operating with 20 or more workers fall under secondary payments covered by Medicare. Medicare benefits for Medicare Part A and B are under secondary payment regulations.
Large Employer Group Health Plan
The secondary payment regulations apply for businesses employing 100 or more employees or for multi-employer groups with 100 or more employees.
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