What is considered a large employer under the MSP rules for working-aged individuals?

Under the Medicare Secondary Payer (MSP) rules for working-aged individuals, a large employer is defined as one that has more than 20 employees. This classification is significant because it determines the primary versus secondary payer status of Medicare in relation to the insurance coverage provided by the employer. Employers with more than 20 employees must offer health benefits that are primary to Medicare for individuals who are aged 65 and older or disabled but still working.

If an employer has 20 or fewer employees, Medicare becomes the primary payer for the health care services for working-aged individuals who are eligible for both Medicare and the employer’s health plan. This distinction is crucial for determining the order of coverage and ensuring compliance with Medicare regulations. Understanding this threshold helps insurance coordinators effectively navigate the complexities of MSP compliance and coordination of benefits for their clients.