Medicare Patient Has Other Health Coverage

40.3 - Medicare Patient Has Other Health Coverage (Rev. 1, 10-01-03) A3-3152.C, HO-260.2.C Payment is not precluded under Medicare if the patient is covered by another health insurance plan or program, which is obligated to provide or pay for the same services. However, Medicare does not pay until after the other payer has paid in the following situations: • Services covered by automobile medical or no-fault insurance; • Services rendered during a specified period of up to 30 months to individuals eligible or entitled solely on the basis of end stage renal disease (ESRD) who are insured under an employer group health plan; • Services rendered to individuals age 65 or over and spouses age 65 or over who are insured under an employer group health plan by virtue of current employment status; • Services rendered to individuals under age 65 entitled to Medicare based on disability and have large group health plan coverage based on the individual’s current employment status or the current employment status of a family member; and • Services covered by workers’ compensation. In these cases, the other plan pays primary benefits and if the other plan does not pay the entire bill, secondary Medicare benefits may be payable. Medicare is also secondary to the extent that a liability insurer has paid for services. See the Medicare Secondary Payment (MSP) Manual, Pub. 100-05.