Summary Chart for ESRD-MSP Rules and Dually

20.1.4– Summary Chart for ESRD-MSP Rules and Dually Entitled Medicare Beneficiaries (Rev. 11755, Issued:12-21-2022, Effective: 01-23-2023, Implementation: 01-23-23) Rule: If Medicare is the proper primary payer for services when eligibility for Medicare based on ESRD is established, Medicare remains the primary payer (during the coordination period and afterwards). Medicare is considered to be the primary payer when Medicare is the only payer or Medicare is legally obligated to be the primary payer to any GHP coverage. Otherwise, Medicare is secondary to any GHP coverage that may exist during the ESRD coordination period. BASIS OF MEDICAL ELIGIBILITY AND GHP COVERAGE APPLICATION OF RULE ESRD Only Medicare secondary to any GHP coverage. Age or Disability entitlement and GHP coverage precede ESRD eligibility with Medicare primary Medicare primary to any GHP coverage. Age or Disability entitlement and GHP coverage precede ESRD eligibility with Medicare secondary Medicare secondary to any GHP coverage. Age or Disability entitlement and ESRD eligibility occur on same day Medicare secondary to any GHP coverage at time of ESRD eligibility or obtained later. ESRD eligibility precedes entitlement based on Age or Disability Medicare secondary to any GHP coverage. Age or Disability entitlement and NO GHP coverage precedes ESRD eligibility Medicare primary to any GHP coverage.