What Is A Medicare Secondary Payer?

A Medicare Secondary Payer or MSP is the process in which Medicare may make a payment after your primary insurance provider determines their payment.

Primary Payer

When a healthcare claim is made to your primary insurance provider it will be processed and paid if the services are covered. If your primary insurance provider does not pay the full amount of the claim, then Medicare may pay part of the costs.

Insurance Plans

Five types of insurance plans exist for of Medicare Secondary Payer. These will include a group health insurance plan, automobile or liability insurance, workers compensation, veterans administration, and end stage renal disease. Group health insurance is provided by employers to actively working employees. This is insurance that also includes COBRA and End Stage Renal Disease. If an accident occurs in a car or at a home, then automobile or liability insurance will apply. The use of automobile insurance will pay for most medical costs when an accident occurs. Injuries that occur on a friend’s properly are covered by liability insurance. Injuries that occur on the job are covered by workers compensation. The provider of this insurance is responsible for paying any healthcare claims first. Healthcare services provided by veterans administration are not covered under Medicare. Medicare will consider payment for services that veterans administration did not pay.

Medicare will be a secondary payer for End Stage Renal Disease when an employee is covered by their employer’s health plan. Medicare Secondary Payer status exists for a period of 30 months.

Secondary Payers

Two types of insurance plans are considered to be secondary payers to original Medicare. Plans include supplemental insurance and group health insurance. Medicare in this instance is the primary payer for a healthcare claim. Medicare will not be a secondary payer for any Medicare Advantage plan.

Comments are closed.