Medicare Secondary Payer Small Employer Exception Plans Explained
The Medical Trust provides the option for eligible employers to apply for the Medicare Secondary Payer (MSP) Small Employer Exception (SEE). If an employer applies for and is approved for the plan, eligible employees and their spouses can choose to participate in the SEE Plan.
Unlock Savings for Participants and Employers
In most cases, Medicare is the secondary payer of healthcare claims for active employees covered under Medicare Part A, and the Medical Trust plan is the first, or primary, payer. Medicare allows for an exception to the secondary payer rule for small employers called the Small Employer Exception. Participation in SEE is voluntary for eligible employers and their employees. It is anticipated that out-of-pocket costs will be lower for plan participants and that employers will save significantly in the cost of health benefits.
Qualifying for SEE
In order to be eligible to participate, employees and/or spouses must be:
- 65 years or older
- Enrolled in Medicare Part A on the basis of age only
- Enrolled in the Medical Trust SEE Plan
- Work for an employer that does not employ 20 employees in 20 or more calendar weeks in the current or preceding calendar year, and the employer must be approved by CMS as a small employer.
What costs are covered?
Under the exception, Medicare will become the primary payer of claims covered under Medicare Part A. These include hospitalization expenses, including inpatient care in hospitals, skilled nursing facilities, hospices, and home healthcare settings. The Medical Trust plan will be the secondary payer. For other coverage, such as doctor visits, outpatient procedures and prescription drug coverage, the Medical Trust plan will be the primary payer. However, if an employee or eligible spouse elects to enroll in Medicare Part B coverage, Medicare will become the primary payer of Part B claims and the Medical Trust plan will be the secondary payer.
How to Learn More
Download more information:
Understanding Health Plan Options for Employees Age 65+
Medicare Secondary Payer SEE Member Fact Sheet
SEE Eligibility Certification Form
For an overview of health benefits, visit your section of the website.
You will be redirected to a new tab for live remote support. Please confirm you're on a call with a Client Services team member to continue.