Opinion ID: 75441
Heading Depth: 3
Heading Rank: 2

Heading: Private Insurers Vis-A-Vis Medicare

Text: We first apply the MSP statute to each private insurer vis-a-vis Medicare. Because Shallenberger’s coverage through Humana after July 1, 1994, when she became eligible for Medicare, was the result of her husband’s then current employment status with the City of Ft. Lauderdale, the MSP statute makes Humana’s coverage primary to Medicare. Humana does not dispute its primary status vis-a-vis Medicare. In contrast, because Harris covered Shallenberger during the same time period as an inactive former employee and not as a result of her current employment status (or that of her spouse), the MSP statute did not prevent Harris from making its coverage secondary to Medicare or, in other words, in making Medicare the primary as opposed to secondary payer of her benefits vis-a-vis Harris. The parties do not appear to dispute Harris’s claims that its plan contains a 8 provision to this effect. Thus, after Shallenberger became eligible for Medicare, Harris became secondary vis-a-vis Medicare. These priorities of each insurer vis-a-vis Medicare appear clear under the MSP statute.