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US · guidance

CMS Pub. 100-05, ch. 2, § 10.1

Individuals Subject to Limitations on Payment

activein force · 2026-08-25 – presentas-observed

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))

History

(Rev. 11755, Issued :12-21-2022, Effective: 01-23-2023, Implementation: 01-23-23)

Provenance

Source
cms.gov
Retrieved
2026-08-25
Edition
iom-2026-08-25
Content hash
03b91079e167f5a4f39ff3440330316c66c4fe631cbd4fb5a6339e670188e496
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