US · guidance
CMS Pub. 100-05, ch. 2, § 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.
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
d45d74b52528245f855d7a6beb21b1e72650f6d66e87957b925dc353bbbcef8c
The link goes to the issuing authority’s own document — the one we read to produce this record. Where a source publishes whole titles rather than sections, your browser may need a moment to jump to the provision.
Unofficial copy of government-published law, reproduced from official sources with full provenance. Not an official publication; verify against official sources before relying on it in a filing. Records in the 'guidance' corpus, and only that corpus, are sub-regulatory (interpretive guidelines, survey procedures) and are not binding law. Validity bounds follow each jurisdiction's declared temporalBasis.