US · guidance
CMS Pub. 100-16, ch. 4, § 130.1
Basic Rule
CMS does not pay for services to the extent that there is a third party that is required to
be the primary payer. The principles on cost-sharing that are discussed below may not
apply in circumstances where CMS has granted an employer group waiver. (See chapter
9 of the MMCM “Employer/Union Sponsored Group Health Plans,” for further
discussion.)
This section only applies to collections related to Part C benefits. Special rules apply to
the collection of cost-sharing related to Part D benefits offered in an MA-PD plan. These
Part D rules are found in chapter 14, “Coordination of Benefits,” of the Prescription Drug
Benefit Manual, publication 100-18, located at: http://www.cms.gov/Regulations-and-
Guidance/Guidance/Manuals/Downloads/Pub100_18.pdf.
History
(Rev. 121, Issued: 04-22-16, Effective: 04-22-16, Implementation: 04-22-16)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
f77eff4e170db117cffc3186e75f100e76de7f1c1ea5daef0dbf121471d99c3a
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