C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER B—MEDICARE PROGRAM › PART 411—EXCLUSIONS FROM MEDICARE AND LIMITATIONS ON MEDICARE PAYMENT › Subpart H—Special Rules: Disabled Beneficiaries Who Are Also Covered Under Large Group Health Plans

42 C.F.R. § 411.201

Definitions

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As used in this subpart—

Entitled to Medicare on the basis of disability means entitled or deemed entitled on the basis of entitlement to social security disability benefits or railroad retirement disability benefits. (§ 406.12 of this chapter explains the requirements an individual must meet in order to be entitled or deemed to be entitled to Medicare on the basis of disability.)

Family member means a person who is enrolled in an LGHP based on another person's enrollment; for example, the enrollment of the named insured individual. Family members may include a spouse (including a divorced or common-law spouse), a natural, adopted, foster, or stepchild, a parent, or a sibling.

Notes of Decisions
Cited in 1 case, 2020–2020 · leading case: Gardi v. United Healthcare Servs., Inc. (S.D. Fla. 2020).
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Gardi v. United Healthcare Servs., Inc. (S.D. Fla. 2020). “” 42 C.F.R. § 411.201 . The general rule is that Medicare is secondary to the LGHP: (a) Medicare benefits are secondary to benefits payable by an LGHP for services furnished during any month in which the individual— (1) Is entitled to Medicare Part A benefits under § 406.”
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