Taking the Mystery out of MSP ESRD

Page Tool

Printable View

Content Section

Examples of ESRD Coordination Periods

The next few pages have time lines to illustrate examples of when Medicare is the secondary vs. primary payer for various ESRD related circumstances. In each of the examples we assumed the beneficiary was on maintenance dialysis thus used a full 3 month waiting period. The timelines are color coded as below for your convenience.

3 month waiting period

Medicare Secondary Payer

GHP covered beneficiary entitled to Medicare solely based on ESRD.
(Prior to September 1, 1997*)

Ex1.gif (4649 bytes)

GHP covered beneficiary entitled to Medicare solely based on ESRD.
(After to September 1, 1997*)

Ex2.gif (5082 bytes)

*On September 1, 1997 the ESRD coordination period changed from 18 months to 30 months; any beneficiary whose coordination started on or after March 1, 1996 has a 30-month coordination period.

3 month waiting period

Medicare Secondary Payer

Beneficiary entitled to Medicare on the basis of ESRD, becomes entitled due to age or disability during the coordination period.
(Prior to 08/10/93, Pre-OBRA 1993)

Ex3.gif (5146 bytes)

Beneficiary entitled to Medicare on the basis age or disability and has GHP coverage through current employment, becomes entitled on the basis of ESRD during the coordination period.
(Prior to 08/10/93, Pre-OBRA 1993)

3 month waiting period

Medicare Secondary Payer

Beneficiary entitled to Medicare due to age or disability and covered by a GHP where Medicare is secondary, then becomes entitled to Medicare on the basis of ESRD.
(Prior to 08/10/93, Pre-OBRA 1993)

GHP covered beneficiary entitled to Medicare due to ESRD and became entitled due to age or disability during the coordination period.
(Coordination period crosses 08/10/93, Pre-OBRA 1993 through OBRA 1993 initial construction)

3 month waiting period

Medicare Secondary Payer

Beneficiary entitled to Medicare due to age or disability and covered by a GHP where Medicare is secondary, then becomes entitled to Medicare on the basis of ESRD too.
(coordination period crosses 08/10/93, Pre-OBRA 1993 through Initial Construction OBRA 1993)

Beneficiary entitled to Medicare due to age or disability with supplemental coverage through a former employer's GHP (Medicare was primary because of retirement or employment status) then develops ESRD.
(Coordination period crosses 8/10/93, but not 04/25/95 Pre-OBRA 1993 through Initial Construction OBRA 1993)

3 month waiting period

Medicare Secondary Payer

Beneficiary entitled due to age, is retired and covered by a GHP through his/her former employer, then develops ESRD. (Coordination period crosses 04/25/95)
(Initial construction OBRA 1993 through present OBRA 1993 Construction)

Beneficiary entitled due to age or disability and Medicare is secondary due to coverage by a GHP, then develops ESRD (Coordination period crosses 04/25/95)
(Initial construction OBRA 1993 through present OBRA 1993 Construction)

3 month waiting period

Medicare Secondary Payer

Beneficiary entitled due to age or disability and Medicare is secondary due to coverage by a GHP, then develops ESRD (Coordination period after 04/25/95)
(Present OBRA 1993 Construction)