Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: October 29, 2014

Program Area: Reinsurance-Contributions (RIC)

Question: To qualify for the exemption set forth in 45 CFR 153.405(a)(1)(iv), what parts of Medicare must an enrollee have as primary under the Medicare Secondary Payer (MSP) rules under section 1862(b) of the Act and the regulations issued thereunder?

Answer: Applicable to All Reinsurance Contributions Benefit Years: As stated in the HHS Notice of Benefit and Payment Parameters for 2014 (78 FR 15456), when an individual has both Medicare coverage and employer-provided group health coverage, the MSP rules under section 1862(b) of the Act would apply, and the group health coverage would be considered major medical coverage only if the group health coverage is the primary payer of medical expenses (and Medicare is the individual's secondary payer) under the MSP rules. For purposes of this exemption from the requirement to make reinsurance contributions, if an employee with employer-provided coverage receives primary coverage under Medicare, Part A or Part B, then that employee does not need to be counted when the employer is calculating its Annual Enrollment Count for the purposes of reinsurance contributions.

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