Medicare Secondary Payer Rules


This practice note discusses how employer group health plans can be designed to provide benefits to eligible employees or retirees, and their dependents, where one or more of them is entitled to Medicare benefits. The general rule is that an employer's health plan may not discriminate against individuals (by not covering them) who would otherwise qualify for full coverage under the health plan but are entitled to Medicare. As described in this practice note, if such an individual is covered by both the employer's health plan and Medicare, the employer's plan must be primary, and Medicare will be treated as the secondary payer.