Secondary Payer (Health Care) Law and Legal Definition

A secondary payer means the plan, insurance policy or program that pays second on a claim for medical care and their payment is only to the extent that payment has not been made. A secondary payer may be either a medicare, medicaid, or other insurance depending on the situation.

A secondary payer will pay the benefits only when the primary payer has paid its full benefits. The benefit that is paid by a secondary payer will be only an amount that when added with the amount paid by a primary payer will give the coverage amount in full. For example, medicare is a "secondary payer" with respect to medical expenses connected with workplace injuries. Thus medicare need not pay full medical expenses and they need to pay only the expense that is left after primary payer’s payment. Any medical expenses paid by the medicare on behalf of a medicare beneficiary who is injured in a work-related accident, will be reimbursement by the responsible party or insurance carrier for that expense.