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Jurisdiction 1 Part B
Could a situation exist where Medicare would not be secondary even if the person has an Employer Group Health Plan (EGHP)?

Answer:
Yes. For example, a beneficiary with only Part B Medicare would have Medicare as primary even if the beneficiary is covered by an employer’s health plan. This is based on Medicare regulations stating that a beneficiary must have both Part A and Part B Medicare for the MSP provisions to apply. Also, Medicare may be primary if the beneficiary’s entitlement to Medicare is based solely on end-stage renal disease (ESRD) and the beneficiary has completed his or her coordination period.

Note: A beneficiary with only Part B coverage is not a common occurrence.

 

last updated on 04/11/2013
ver 1.0.37