How Medicare Secondary Payer Works

• You do not have any other type of insurance.
• You’re 65 or older and covered through work or your spouse’s work, and the company (and its parent company) has less than 20 employees. (For example, you might work at store with 10 other people. But if that store is part of a bigger company with many employees, it would count as more than 20 employees.)
• You’re 65 or older and have an employer retirement health plan.

• You’re 65 or older and covered through work or your spouse’s work, and the company has 20 or more employees.
• You’re 65 or older, self-employed and covered through work or your spouse’s work, and the company has 20 or more employees.
• You’re entitled to Medicare and were in an accident or got hurt, and someone else or another insurance company (not yours or Medicare) is the primary payer.
• You’re entitled to Medicare and you have an injury or illness related to your job, where Workers’ Compensation is the primary payer.

There are also rules about Medicare as the secondary payer if:

• You’re disabled.
• You have end-stage renal (kidney) disease.
• You have COBRA (Consolidated Omnibus Budget Reconciliation Act) coverage.

If you have any questions, call us at (615) 936-3938.

The Benefits Coordination and Recovery Center (BCRC) collects information on your health care coverage and stores it in your Medicare record. They get this information from your doctor and other providers, your health plan, and your employer.

Another important way they get this information is from the Medicare Secondary Claim Development Questionnaire. This is a form that Medicare sends to you to find out if you have other insurance that may have to pay before Medicare. The form asks:

• If you have other health insurance or coverage from your current job
• If you get black lung benefits, workers' compensation benefits, or treatment for an injury or illness that someone else could be held liable for, or that are covered under no-fault car insurance
• If you have other health insurance or coverage from a family member's current job

This form is mailed to you for a few reasons:

• When a claim is submitted to Medicare with an explanation of benefits (EOB) attached
• When you or your lawyer tell us that another insurance should be paying the bill for a healthcare claim
• When an insurance company sends MSP information to a contractor or the BCRC

Your Medicare record must be updated every time you make a change to your health care coverage. It should show if another insurance should pay before Medicare. This is important because paying your claim right the first time prevents mistakes and problems with your healthcare plans. Here are things you need to do to help make sure your Medicare claims are paid correctly.

• If you get a Medicare Secondary Claim Development Questionnaire, fill it out and return it right away.
• Tell the BCRC about any changes in your health insurance due to you, your spouse, or a family member’s employment or coverage changes.
• Tell your doctor and other providers if you have insurance besides Medicare.
• Know that any change in your employment, including if you retire or your employer changes health insurance companies, may affect your claims payment.

The Benefits Coordination and Recovery Center is open Monday through Friday, from 8:00 a.m. to 8:00 p.m. eastern time. They are not open on holidays. You can call them at (855) 798-2627. (TTY/TDD: (855) 797-2627 if you’re hearing- or speech-impaired).

To learn more about Medicare as a secondary provider (MSP), visit CMS.gov