CMS Pub. 100-16, ch. mc86c18b, § 180

Medicare

(Rev. 30, 09-05-03)

Under §1862(b)(1)(A) of the Act, if an employer has 20 or more employees (calculated

as described below) and offers a group health plan (referred to here as an EGHP), the

EGHP is the primary payer for individuals who are 65 or over, and who are covered

under the plan based on current employment of the individual or the individual's spouse.

(Medicare remains the primary payer for retirees.)

Medicare is secondary only if the individual is entitled to Medicare Part A. Generally,

Medicare is not secondary for persons over age 65 who have ESRD.

The law also prohibits EGHPs from taking into account, in furnishing services, that an

individual is entitled to Medicare benefits, and requires that employees or their spouses,

who are 65 or over, be entitled to the same benefits under the same conditions as

individuals under age 65. If the EGHP violates either of these provisions, Medicare is

entitled to collect primary payments from the organization as if the violations had not

occurred. The nonconforming plan is also subject to an excise tax imposed under the

Internal Revenue Code (IRC).