General

10.1 – General (Rev. 12438; Issued: 01-04-24; Effective: 02-06-24; Implementation: 02-06-24) Section 1862(b) of the Social Security Act (the Act) gives Medicare the right to recover payments it has made on behalf of private insurers that are the primary (or “first”) payers for Medicare beneficiaries. In situations where Medicare is a “secondary” payer, the primary payer must reimburse Medicare for any benefits that Medicare has conditionally or mistakenly paid as primary on behalf of a beneficiary. The Medicare Secondary Payer (MSP) program ensures that Medicare is aware of situations where it should not be the primary (the first) payer of claims. If a beneficiary has Medicare and other health insurance, Medicare Coordination of Benefits (COB) rules decide which entity pays first. Medicare may make conditional payments on behalf of beneficiaries during COB activities, so that beneficiaries can maintain continual Medicare coverage throughout the COB period. Any such payments are conditioned on reimbursement to the appropriate Medicare trust fund.