Employers with Medicare-eligible employees face strict federal rules governing how employer-sponsored health plans must coordinate with Medicare. These rules, known as the Medicare Secondary Payer (MSP) regulations, determine who pays first, regulate what employers may say or do, and impose significant penalties for non-compliance.
Failure to follow these requirements can expose employers to civil monetary penalties, excise taxes, repayment of claims, and enforcement action from CMS, the IRS, and the Department of Labor.
Given its significance, this edition of the Compliance Chronicle is devoted to providing a consolidated, compliance-focused overview for employer-sponsored plans, incorporating MSP rules, financial incentive prohibitions, Section 125 cafeteria plan considerations, and the critical distinction between employers under and over 20 employees.