Coordination for ESRD Patients

310 - Coordination for ESRD Patients (Rev. 4, 10-01-01) Medicare is secondary to benefits payable under an EGHP in the case of individuals who are entitled to benefits solely or partly on the basis of ESRD during a period of 18 months. During a period of 30 months, Medicare is secondary for all Medicare services, not just ESRD-related services. At the end of the coordination period, Medicare becomes the primary payer for these Medicare enrollees. The 30-month period begins with the earlier of the first month of Part A eligibility or entitlement based solely or partly on ESRD. If the basis for an individual’s entitlement to Medicare changes from ESRD to age 65 or disability, the coordination period will continue. In like respects, if the individual is entitled to Medicare benefits for other reasons, the coordination period will apply once the individual is determined to have ESRD. The following steps are involved in determining Medicare responsibility as the secondary or primary payer: • Identify Medicare members entitled solely or partly because of ESRD; • Determine the period within which benefits must be coordinated; and • Determine if services rendered can be paid for by an EGHP.