Commission for Case Manager Certification (CCMC) Practice Exam

Under the Omnibus Budget Reconciliation Act (OBRA), Medicare is designated as the secondary payer for individuals who have access to employer group health plans. This means that when an individual is eligible for both Medicare and an employer-sponsored health insurance plan, the employer plan pays first for medical services, and then Medicare can cover the remaining costs.

This provision typically applies to situations where the employer has 20 or more employees. In these cases, the employer group health plan is responsible for paying medical claims before Medicare does, thus allowing Medicare to act as a secondary payer rather than the primary source of coverage. This arrangement helps to reduce overall costs for the Medicare program and provides a more efficient payment structure for beneficiaries who have access to dual coverage.

The other options do not align with the regulations established by OBRA. Medicare being the primary payer would contradict the framework set by the Act. Furthermore, stipulations like requiring employer group plans to be free or to cover all employees are not addressed by OBRA, which focuses primarily on the coordination of benefits between Medicare and employer-sponsored group health plans.