CMS Pub. 100-16, ch. mc86c17b, § 340.3.3

Medicare is not secondary for individuals who perform services as members of a

religious order whose members are required to take a vow of poverty if those activities

are considered employment only because of an election of Social Security coverage by

the order under §3121(r) of the Internal Revenue Code. This means Medicare is primary

to the group health coverage provided as a result of those activities. Those activities may

not be considered in determining whether a member of the order is considered an

employed individual for purposes of the working aged provision.

This exception applies only to religious functionaries who are members of religious

orders and who have taken a vow of poverty. It does not apply to Protestant and Jewish

clergy, who do not take the vow of poverty. It does not usually apply to Catholic parish

priests, most of who do not take vows of poverty, nor does it apply to any member of a

religious order who has not taken a vow of poverty. Furthermore, the exception does not

apply to group health coverage based on work performed by members of religious orders

for employers outside of their orders. Also, the MSP definition of “employed” remains

applicable to employees of religious orders who provide service and are reimbursed by

the orders, but who are not themselves members of the orders. The usual MSP rules apply

to such individuals.