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 D—Limitations on Medicare Payment for Services Covered Under Liability or No-Fault Insurance

42 C.F.R. § 411.51

Beneficiary's responsibility with respect to no-fault insurance

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(a) The beneficiary is responsible for taking whatever action is necessary to obtain any payment that can reasonably be expected under no-fault insurance.

(b) Except as specified in § 411.53, Medicare does not pay until the beneficiary has exhausted his or her remedies under no-fault insurance.

(c) Except as specified in § 411.53, Medicare does not pay for services that would have been covered by the no-fault insurance if the beneficiary had filed a proper claim.

(d) However, if a claim is denied for reasons other than not being a proper claim, Medicare pays for the services if they are covered under Medicare.

Notes of Decisions
Cited in 5 cases (2 in the last 5 years), 1998–2026 · leading case: Ocean Harbor Cas. Ins. v. MSPA Claims, 1
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Ocean Harbor Cas. Ins. v. MSPA Claims, 1 (2018) fladistctapp “" 42 C.F.R. § 411.51 (emphasis added). As this language indicates, the Secondary Payer Act does not supersede an existing State insurance policy: it merely requires the exhaustion of the benefits under that policy.”
Lynette Duncan v. Liberty Mutual Ins. Co. (2021) ca6 · cites it 5× “Regulatory Burden The only statutory harms that Lynette Duncan asserts are a statutory violation and a regulatory burden under 42 C.F.R. § 411.51 (a). As explained above, a statutory violation of the MSPA does not bestow Article III standing on a private plaintiff who was not…”
Ocean Harbor Cas. Ins. v. MSPA Claims, 1 (2018) fladistctapp “" 42 C.F.R. § 411.51 (emphasis added). As this language indicates, the Secondary Payer Act does not supersede an existing State insurance policy: it merely requires the exhaustion of the benefits under that policy.”
MSP Recovery Claims, Series LLC, a Delaware limited liability company; and Series 16-08-483, a designated series of MSP (2026) nywd “For example, 42 C.F.R. §411.51 , entitled “Beneficiary’s responsibility with respect to no-fault insurance”, provides: “(a) The beneficiary is responsible for taking whatever action is necessary to obtain payment that can reasonably be expected under no-fault insurance.”
Smith v. Farmers Insurance Exchange (1998) coloctapp · cites it 2× “Also, 42 C.F.R. §411.51 (a) provides that “the beneficiary is responsible for taking whatever action is necessary to obtain any payment that can reasonably be expected under no-fault insurance.”
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