Individuals Subject to Limitations on Payment

10.1 - Individuals Subject to Limitations on Payment (Rev. 11755, Issued :12-21-2022, Effective: 01-23-2023, Implementation: 01-23-23) Medicare pays secondary for Part A and Part B benefits for an individual who: • Is age 65 or over; • Is entitled to Part A (hospital insurance) on the basis of the individual’s own Social Security or Railroad Retirement earnings record, or Federal quarters of coverage, or the earnings record or the Federal quarters of coverage of another person; and • Is covered on the basis of individual's own current employment status or the current employment status of the individual's spouse. Re-employed Retirees and Annuitants If a retiree or annuitant returns to work even for temporary periods, the employer is required to provide the same coverage under the same conditions that the employer furnishes to other similarly situated employees (i.e., non-retirees). Medicare is the secondary payer to the GHP that the employer provides to the re-employed retiree even if the premiums for coverage in the plan are paid from a retirement pension or fund. Medicare is also secondary payer for individuals associated with the employer in a business relationship such as consultants who are former employees, if the employer provides insurance coverage for other such individuals. (See 42 CFR §411.172(d))