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. § 411.204

Medicare benefits secondary to LGHP benefits

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(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 § 406.12 of this chapter;

(2) Is covered under an LGHP; and

(3) Has LGHP coverage by virtue of his or her own or a family member's current employment status.

(b) Individuals entitled to Medicare on the basis of disability who are also eligible for, or entitled to, Medicare on the basis of ESRD. If a disabled individual is, or could upon filing an application become, entitled to Medicare on the basis of ESRD, the coordination of benefits rules of subpart F of this part apply.

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. § 411.204 (a). However, under COBRA coverage, Medicare is the primary payer: (a) General rule.”
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