US · guidance
CMS Pub. 100-16, ch. mc86c17b, § 350.5.1
Individuals Not Subject to This Limitation Payment
Medicare is not secondary for:
• Individuals entitled, or who would upon application be entitled, to Medicare
under the ESRD provision that are not in the coordination period, i.e., individuals
who have ESRD even though their current Medicare entitlement is on the basis of
disability;
• Individuals who are covered by an EGHP of employers of less than 100
employees, unless the EGHP is a multi-employer plan in which there is at least
one employer of 100 or more employees; and
• Individuals whose coverage by an LGHP is not based on either employment or a
relationship to an employee, employer, or an individual associated with an
employer in a business relationship. For example, Medicare is primary for a
disabled individual who is covered under an LGHP as a retired former employee,
and who does not meet any of the criteria in §30.1 or who is the spouse of a
retired former employee.
History
(Rev. 4, 10-01-01)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
2002b5c14fdd6efd1756e7ce4cd44ed5a24f051026be9f5f8811db019f526ffb
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