When Medicare Secondary Benefits Are Payable and Not Payable

20.8 - When Medicare Secondary Benefits Are Payable and Not Payable (Rev. 11755, Issued:12-21-22, Effective: 01-23-23, Implementation: 01-23-23) A/B MACs and DME MACs may pay Medicare secondary benefits when a provider, physician or other supplier, or beneficiary submits a claim that is payable under Medicare’s coverage requirements and the primary plan does not pay the entire charge. Medicare will not make a secondary payment if the provider/physician/supplier accepts, or is obligated to accept, the primary plan payment as full payment or full satisfaction of the patient’s responsibility. When a primary plan’s payment for Medicare covered services is less than the provider's, physician’s, or other supplier’s charges for those services and less than the gross amount payable by Medicare, and the provider, physician, or other supplier does not accept and is not obligated to accept the primary plan’s payment as full payment, then A/B MACs and DME MACs can process Medicare secondary payment as appropriate. See 42 CFR § 411.32, 411.33, 411.162, 411.172 and 411.204.