The Congress Should Consider Amending the Medicare Secondary Payer Provisions To Include Disability Beneficiaries

The Congress has amended the Social Security Act three times to make Medicare the secondary payer to employer-sponsored group health insurance. As a result, when Medicare beneficiaries between the ages of 65 and 70 and those with end stage renal disease are covered by group health insurance, this insurance pays for medical services to the extent of its benefits and Medicare pays the remainder. In addition, the Congress is considering extending the working aged provision to beneficiaries 70 and older. Disabled Medicare beneficiaries represent the last major group for whom Medicare is the primary payer when they are also covered by employer-sponsored group health insurance. GAO estimates that 9 percent of disabled Medicare beneficiaries under age 65 are covered by their spouses' employer-sponsored group health insurance. GAO believes that the Congress should consider extending Medicare's secondary payer status to disabled beneficiaries. Doing so could reduce Medicare payments by up to $491 million in fiscal year 1986 and by up to $2.9 billion during fiscal years 1986-90.

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