What is Medicare Secondary Payer?

Medicare Secondary Payer is the term used for when a Medicare beneficiary has other insurance or coverage that is the primary payer, based on a federal MSP provision, for the beneficiary’s healthcare services. As a result, Medicare is the secondary payer to that other insurance or coverage for those services.

Each MSP provision has criteria and/or conditions that the beneficiary’s situation must meet for the MSP provision to apply.

• If the beneficiary’s situation meets all criteria and/or conditions of an MSP provision, then the other insurance or coverage is the primary payer and Medicare is the secondary payer for the beneficiary’s healthcare services.
• If the beneficiary’s situation does not meet all criteria and/or conditions of an MSP provision, then Medicare is the primary payer for the beneficiary’s healthcare services.

There are three GHP MSP provisions and the remaining MSP provisions are non-GHP MSP provisions. To learn more about MSP and the MSP provisions, review the following resources:

• CMS IOM Publication 100-05, Medicare Secondary Payer Manual,
  • Chapter 1, General MSP Overview
  • Chapter 2, MSP Provisions
• CMS Medicare Secondary Payer web page
• MLN® Booklet: Medicare Secondary Payer

Reviewed 10/25/2023