End-Stage Renal Disease (ESRD)

20.2 - End-Stage Renal Disease (ESRD) Rev. 11755, Issued:12-21-22, Effective: 01-23-23, Implementation: 01-23-23) Medicare benefits are secondary to benefits payable under a GHP for individuals eligible for, or entitled to, Medicare Part A on the basis of ESRD during a period of up to 30 months if Medicare was not already the proper primary payer for the individual on the basis of entitlement due to age or disability at the time that this individual became eligible or entitled to Medicare Part A on the basis of ESRD, pursuant to 42 CFR § 411.162. (See Section 1862(b)(1)(C) of the Act.) . The coordination period begins when the individual is eligible for Medicare Part A. Medicare is secondary during this period even if the employer policy or plan contains a provision stating that its benefits are secondary to Medicare, or otherwise excludes or limits its payments to Medicare beneficiaries. Under this provision, the GHP is billed first for services provided to a Medicare ESRD beneficiary. If the GHP does not pay for covered services in full, Medicare may pay secondary benefits in accordance with current billing instructions. This provision applies to all Medicare covered items and services (not just treatment of ESRD) furnished to beneficiaries who are in the coordination period.