Medicare Secondary Payer (MSP) is the term generally used when the Medicare program does not have primary payment responsibility - that is, when another entity has the responsibility for paying before Medicare.  See 42 U.S.C. 1395y(b) [section 1862(b) of the Social Security Act], and 42 C.F.R. Part 411, for the applicable statutory and regulatory provisions.

Information for Employers regarding MSP Situations

By law, all employers other than those employers that qualify for an exception are required to complete a questionnaire on the group health plan that Medicare-eligible workers and their spouses choose. The Data Match process identifies situations where another payer is primary to Medicare and helps Medicare intermediaries and carriers identify claims on an ongoing basis for which Medicare should not be the primary payer.

A Voluntary Data Sharing Agreements (VDSAs) is an agreement that allows employers and CMS to send and receive group health plan enrollment information electronically. CMS has entered into VDSAs with numerous large employers. Where discrepancies occur in the VDSAs, employers can provide enrollment/disenrollment documentation. The VDSA program includes Part D information, enabling VDSA partners to submit records with prescription drug coverage, be it primary or secondary to Part D.

The Centers for Medicare & Medicaid Services (CMS) recommends the following for employers:

• Ensure that your plans identify those individuals to whom the MSP requirement applies;
• Ensure that your plans provide for proper primary payments where by law Medicare is the secondary payer;
• Ensure that your plans do not discriminate against employees and employees' spouses age 65 or over, people who suffer from permanent kidney failure, and disabled Medicare beneficiaries for whom Medicare is secondary payer; and
• Accurately complete and submit Data Match reports timely on identified employees.