US · guidance
CMS Pub. 100-05, ch. 5, § 40.3.3
GHP Gives Medicare Beneficiary Choice of Using Preferred Provider
If a Medicare beneficiary is given the choice by the GHP whether to choose a preferred provider or to
obtain medical services from a non-preferred provider, the beneficiary may choose the non-preferred
provider and Medicare makes secondary payments based on the amount paid by the GHP. However,
see Chapter 1 of Pub. 100-05 for rules governing employer-sponsored HMO/CMPs when Medicare
cannot make primary payments.
History
(Rev. 11550; Issued: 08 -12-22; Effective: 10 -13-22; Implementation:10 -13-22)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
c240ff1ab1767ce86aa747796cff8f0502b08aab3b1dc7f1a6440d47c1bb24a3
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