Accession Number : ADA187584

Title :   Medicare: Legislative Amendment Would Avoid Adverse Effects on Disabled Beneficiaries.

Corporate Author : GENERAL ACCOUNTING OFFICE WASHINGTON DC HUMAN RESOURCES DIV

PDF Url : ADA187584

Report Date : Sep 1987

Pagination or Media Count : 9

Abstract : Legislation that became effective January 1, 1987, amended Medicare law to require certain employer-sponsored group health insurers that cover disabled beneficiaries to pay the medical claims of such beneficiaries ahead of Medicare. A disagreement has arisen about whether this law applies to health plans sponsored by government employers. The Health Care Financing Administration (HCFA), which administers the Medicare program, interprets the law as applying to government-sponsored health plans. Administrators of federal, state, and local government-sponsored health plans. Administrators of federal, state, and local government-sponsored plans, on the other hand, assert that the law does not apply to such plans. Both arguments have merit. Until this issue is resolved, disabled beneficiaries who have health coverage under Medicare and a government-sponsored plan can be faced with a situation in which neither Medicare nor the plan will pay for services. We recommend that the legislative committees for Medicare include in their fiscal year 1988 reconciliation bills an amendment to the Social Security Act so that there can be no doubt that Medicare is the secondary payer to government plans under section 1862(b)(4) to the same extent that the section applies to other health plans.

Descriptors :   *LEGISLATION, *MEDICAL SERVICES, *INSURANCE, ADMINISTRATIVE PERSONNEL, ADVERSE CONDITIONS, HEALTH, MEDICINE, PLANNING, CONTRACT ADMINISTRATION, CONTRACTS, PUBLIC HEALTH

Subject Categories : Economics and Cost Analysis
      Government and Political Science
      Sociology and Law

Distribution Statement : APPROVED FOR PUBLIC RELEASE