In 1980, Congress began passing provisions that made Medicare a
secondary payer to certain primary plans in particular
situations. For example, Medicare is the secondary payer to
coverage provided by Group Health Plans (GHPs) if a beneficiary
is employed at a company with 20 or more employees, or if a
beneficiary’s spouse (of any age) is enrolled in a GHP through
an employer. Employees may reject coverage through a GHP, so
Medicare will become the primary payer, but employers will not
be able to offer secondary coverage for services covered by
Medicare. There are exceptions, however. For example, Medicare
is the secondary payer for up to 30 months for people with End-
Stage Renal Disease (ESRD) who are covered by a GHP. The period
begins when the employee becomes eligible for Medicare. Medicare
is also secondary insurance for people under 65 years old who
are living with a disability and covered by a Large Group Health
Plan (LGHP) (100 employees or more), or who have a family member
covered by such a plan. Med