Is Medicare the Primary or Secondary Payer?

Published 10/11/2022

Are you unsure if Medicare should pay as the primary or secondary insurer for your patient? Use our MSP tool to answer your questions and find your solutions. The questionnaire is easy and quick to use for all of your patients.

Before You Begin: Facts to Know

  • For patients that have both Medicare and Medicaid and no other insurance, Medicare is the primary payer
  • In most cases, federal law takes precedence over state laws and private contracts. Even if a state law or insurance policy states that they are a secondary payer to Medicare, the MSP regulations should be followed to determine the correct primary payer.
  • Medicare records may not reflect the patient's current insurance status. If you find that there is a discrepancy between Medicare records and the patient's current insurance status, call the MSP Contractor at 855–798–2627 or TDD/TYY 855–797–2627. The MSP Contractor may also need to speak to the patient. However, providers are permitted to call.
  • In some cases, if a patient or his/her spouse is working and is covered by an employer group health plan (EGHP), you must know the number of people employed by the company in order to use this tool most effectively. Either you or the patient may contact the employer to obtain this information.
  • Providers are required to file claims on behalf of their Medicare patients, including patients for whom Medicare is the secondary payer
  • These claims must be filed electronically, unless you qualify for a waiver to submit paper claims

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