CMS Pub. 100-16, ch. mc86c17b, § 310

Medicare is secondary to benefits payable under an EGHP in the case of individuals who

are entitled to benefits solely or partly on the basis of ESRD during a period of 18

months. During a period of 30 months, Medicare is secondary for all Medicare services,

not just ESRD-related services. At the end of the coordination period, Medicare becomes

the primary payer for these Medicare enrollees.

The 30-month period begins with the earlier of the first month of Part A eligibility or

entitlement based solely or partly on ESRD.

If the basis for an individual’s entitlement to Medicare changes from ESRD to age 65 or

disability, the coordination period will continue. In like respects, if the individual is

entitled to Medicare benefits for other reasons, the coordination period will apply once

the individual is determined to have ESRD. The following steps are involved in

determining Medicare responsibility as the secondary or primary payer:

• Identify Medicare members entitled solely or partly because of ESRD;

• Determine the period within which benefits must be coordinated; and

• Determine if services rendered can be paid for by an EGHP.