No-Fault Insurance

20.5 - No-Fault Insurance (Rev. 11755, Issued:12-21-22, Effective: 01-23-23, Implementation: 01-23-23) Medicare is secondary to any no-fault insurance, including all forms of automobile no-fault insurance, automobile medical payments, and non-automobile no-fault insurance. pursuant to 42 CFR § 411.50. (See Pub. 100-05, Chapter 2, §60.) No-fault insurance is a form of insurance that pays for medical expenses for injuries sustained on the property or premises of the insured, or in the use, occupancy, or operation of an automobile regardless of who may have been responsible for causing the accident. MedPay is a form of no-fault insurance even when included in automobile insurance of any type. Payment may not be made by Medicare for otherwise covered 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 no-fault insurance. A conditional Medicare payment may be made if the no-fault insurance has not paid and cannot reasonably be expected to make payment promptly. See 42 CFR § 411.53.