Coordination With No-Fault Insurance

160 - Coordination With No-Fault Insurance (Rev. 30, 09-05-03) Medicare may not pay for any items or services to the extent that payment has been made, or can reasonably be expected to be made, for the items or services, under any no- fault insurance (including a self-insured organization). Medicare is secondary to no-fault insurance even if state law or a private contract of insurance stipulates that Medicare is primary. If Medicare payments have been made, but should not have been because they are excluded under this provision, or if the payments were made on a conditional basis, they are subject to recovery. The issue in cases involving accident related medical expenses is whether no-fault benefits can be paid for these particular services. If so, the no-fault insurance is primary. 21 If not, Medicare may be primary. Primary Medicare benefits cannot be paid merely because the beneficiary wants to save his/her no-fault insurance benefits to pay for future services. Since no-fault insurance benefits would be currently available in that situation, they must be used before Medicare. Expenses for services for which Medicare payment may not be made because payment has been made or can reasonably be expected to be made promptly under any no-fault insurance are credited toward Part A or Part B deductible amounts. Inpatient care that is paid for by a third party payer is not counted against the number of days available to the beneficiary under Medicare Part A.