What is the primary purpose of a conditional payment?

The primary purpose of a conditional payment is to prevent out-of-pocket costs for beneficiaries. Conditional payments are made by Medicare on behalf of beneficiaries when there is a primary payer (such as auto insurance or liability insurance) that is responsible for the medical expenses but has not yet made a payment. The goal is to ensure that beneficiaries receive necessary medical care without delay or additional out-of-pocket expenses while the primary payer’s responsibility is being established.

By facilitating this process, conditional payments help protect beneficiaries from the financial burden of medical costs that should be covered by another party. This mechanism allows Medicare to intervene in a timely manner, ensuring individuals can access needed treatment without facing prohibitive costs due to delays in payment processing by other insurers.