Medicare is a health insurance program designed to assist the nation's elderly to meet hospital, medical, and other health costs. Medicare is available to most individuals 65 years of age and older. Medicare has also been extended to persons under age 65 who are receiving disability benefits from Social Security or the Railroad Retirement Board, and those having End Stage Renal Disease (ESRD). The Centers for Medicare & Medicaid Services (CMS) is the federal agency that manages Medicare.
When a Medicare beneficiary has other health insurance or coverage, each type of coverage is called a "payer." "Coordination of benefits" rules decide which one is the primary payer (i.e., which one pays first). To help ensure that claims are paid correctly, a variety of methods and programs are used to identify situations in which Medicare is the secondary payer.
Medicare Beneficiaries with Other Health Insurance
When a Medicare beneficiary has other insurance (like employer group health coverage), rules dictate which payer is responsible for paying first. Please review the Reporting Other Health Insurance page for information on how and when to report other health plan coverage to CMS. This page includes information on the Initial Enrollment Questionnaire (IEQ) and Medicare Secondary Payment Development Questionnaires.
Medicare Beneficiaries and No-Fault, Liability, or Workers’ Compensation Cases
Applicable Medicare law says that liability insurance (including self-insurance), no-fault insurance, and workers’ compensation must pay for medical items and services before Medicare pays. The Medicare beneficiary or his/her attorney should inform Medicare as soon as they become aware other insurance is available or if they feel another party was responsible for causing the beneficiary’s injuries or illness. Additional information on this topic can be found on the Liability, No-Fault and Workers’ Compensation Reporting page.
When a Medicare beneficiary is involved in a no-fault, liability, or workers’ compensation case, his/her doctor or other provider may bill Medicare if the insurance company responsible for paying primary does not pay the claim promptly (usually within 120 days). In these cases, Medicare may make a conditional payment to pay the bill. These payments are "conditional" because if the beneficiary receives an insurance or workers’ compensation settlement, judgment, award, or other payment, Medicare is entitled to be repaid for the items and services it paid. Please review the Medicare’s Recovery Process page for more information.
How to sign-up for Beneficiary Services Web page updates
CMS provides the ability for you to be automatically notified when changes are made to the Beneficiary Services Web pages. If you have not already signed up for these notifications, please click the Sign-up for Beneficiary Services Web Page Update Notification link found in the Related Links section below to subscribe to Beneficiary Web page updates. When notifications and new information are available, you will be notified via e-mail. Announcements regarding updates will be posted to this page.
- Page last Modified: 12/22/2014 2:34 PM
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