Prior to 8/10/93, Medicare was primary payer for an individual who had coverage based
on age or disability and who was also eligible for, or entitled to, Medicare based
on ESRD, even if the individual was also covered under a GHP. Effective 8/10/93, Medicare
remains secondary payer for the full ESRD coordination period even if the individual
subsequently becomes entitled to Medicare on the basis of age or disability.
If an individual who is entitled to Medicare on the basis of age or disability and
covered under a GHP based on current employment status subsequently becomes eligible
for R-HI (whether or not an application for R-HI is filed), Medicare becomes secondary
payer for the ESRD coordination period. At the end of the coordination period, Medicare
becomes primary payer even if the individual remains covered under the GHP based on
current employment status.
However, if an individual entitled to Medicare on the basis of age or disability and
covered under a GHP based on retirement subsequently becomes eligible for R-HI, Medicare
remains the primary payer (i.e., there is no ESRD coordination period).