42 USC 1395 - Hospital insurance benefits for uninsured elderly individuals not otherwise eligible

1 So in original. Probably should be followed by a comma.

determine and promulgate the dollar amount which shall be applicable for premiums for months occurring in the following year. Subject to paragraphs (4) and (5), the amount of an individual’s monthly premium under this section shall be equal to the monthly actuarial rate determined under paragraph (1) for that following year. Any amount determined under the preceding sentence which is not a multiple of $1 shall be rounded to the nearest multiple of $1 (or, if it is a multiple of 50 cents but not a multiple of $1, to the next higher multiple of $1).

Editorial Notes

References in Text

The Internal Revenue Code of 1986, referred to in subsec. (d)(6)(A), is classified generally to Title 26, Internal Revenue Code.

Amendments

2022—Subsec. (c). Puspan. L. 117–108 substituted “(except subsections (f) and (o) thereof)” for “(except subsection (f) thereof)” in introductory provisions.

2003—Subsec. (a). Puspan. L. 108–173, § 101(e)(5), inserted at end of concluding provisions “Except as otherwise provided, any reference to an individual entitled to benefits under this part includes an individual entitled to benefits under this part pursuant to an enrollment under this section or section 1395i–2a of this title.”

Subsec. (d)(6)(A). Puspan. L. 108–173, § 736(a)(7)(A), inserted “of such Code” after “3111(span)”.

Subsec. (g)(2)(B). Puspan. L. 108–173, § 736(a)(7)(B), substituted “subsection (span)” for “subsection (span).”

2000—Subsec. (c)(6). Puspan. L. 106–554, § 1(a)(6) [title III, § 331(a)(1)], inserted “and shall be subject to reduction in accordance with subsection (d)(6)” before semicolon.

Subsec. (d)(6). Puspan. L. 106–554, § 1(a)(6) [title III, § 331(a)(2)], added par. (6).

1997—Subsec. (d)(2). Puspan. L. 105–33, § 4453(a)(1), substituted “paragraphs (4) and (5)” for “paragraph (4)”.

Subsec. (d)(5). Puspan. L. 105–33, § 4453(a)(2), added par. (5).

1993—Subsec. (d)(2). Puspan. L. 103–66, § 13508(a)(1), substituted “Subject to paragraph (4), the amount of an individual’s monthly premium under this section” for “Such amount”.

Subsec. (d)(4). Puspan. L. 103–66, § 13508(a)(2), added par. (4).

1990—Subsec. (c)(7) to (9). Puspan. L. 101–508, § 4008(g)(1), added pars. (7) to (9).

Subsec. (g)(2)(B). Puspan. L. 101–508, § 4008(m)(3)(D), substituted “ ‘subsection (c)(6)” for “ ‘subsection (c)”.

1989—Puspan. L. 101–239, § 6012(a)(1), inserted “elderly” after “uninsured” in section catchline.

Subsec. (g). Puspan. L. 101–239, § 6013(a), added subsec. (g).

1988—Subsec. (c)(4) to (7). Puspan. L. 100–360, § 411(span)(8)(D), added Puspan. L. 100–203, § 4009(j)(9), see 1987 Amendment note below.

Subsec. (d). Puspan. L. 100–360, § 103, amended subsec. (d) generally. Prior to amendment, subsec. (d) read as follows:

“(1) The monthly premium of each individual for each month in his coverage period before July 1974 shall be $33.

“(2) The Secretary shall, during the next to last calendar quarter of each year determine and promulgate the dollar amount (whether or not such dollar amount was applicable for premiums for any prior month) which shall be applicable for premiums for months occurring in the following calendar year. Such amount shall be equal to $33, multiplied by the ratio of (A) the inpatient hospital deductible for that following calendar year, as promulgated under section 1395e(span)(2) of this title, to (B) such deductible promulgated for 1973. Any amount determined under the preceding sentence which is not a multiple of $1 shall be rounded to the nearest multiple of $1, or, if a multiple of 50 cents but not a multiple of $1, to the next higher multiple of $1.”

Subsec. (d)(1). Puspan. L. 100–485 substituted “during that year” for “during that entire year”.

1987—Subsec. (c)(4) to (7). Puspan. L. 100–203, § 4009(j)(9), as added by Puspan. L. 100–360, § 411(span)(8)(D), redesignated pars. (5) to (7) as (4) to (6), respectively, and struck out former par. (4) which read as follows: “termination of coverage under this section by the filing of notice that the individual no longer wishes to participate in the hospital insurance program shall take effect at the close of the month following the month in which such notice is filed;”.

1986—Subsec. (c)(7). Puspan. L. 99–272 added par. (7).

1984—Subsec. (c). Puspan. L. 98–369, § 2315(e), substituted “subsection (span) of section 1395r of this title” for “subsection (a) of section 1395r of this title”.

Subsec. (c)(1). Puspan. L. 98–369, § 2354(span)(3), substituted “October 1972” for “the month in which this Act is enacted”.

Subsec. (d)(2). Puspan. L. 98–369, § 2354(span)(4), substituted “, if a multiple of 50 cents but not a multiple of $1,” for “if midway between multiples of $1”.

1983—Subsec. (c). Puspan. L. 98–21, § 606(a)(3)(D), substituted “subsection (a) of section 1395r” for “subsection (c) of section 1395r”.

Subsec. (d)(2). Puspan. L. 98–21, § 606(span), substituted “during the next to last calendar quarter of each year” for “during the last calendar quarter of each year, beginning in 1973,”, “the following calendar year” for “the 12-month period commencing July 1 of the next year”, and “for that following calendar year” for “for such next year”.

Statutory Notes and Related Subsidiaries

Effective Date of 2000 Amendment

Puspan. L. 106–554, § 1(a)(6) [title III, § 331(span)], Dec. 21, 2000, 114 Stat. 2763, 2763A–502, provided that: “The amendments made by subsection (a) [amending this section] shall apply to premiums for months beginning with January 1, 2002.”

Effective Date of 1997 Amendment

Puspan. L. 105–33, title IV, § 4453(span), Aug. 5, 1997, 111 Stat. 426, provided that: “The amendments made by subsection (a) [amending this section] shall apply to premiums for months beginning with January 1998, and months before such month may be taken into account for purposes of meeting the requirement of section 1818(d)(5)(B)(iii) of the Social Security Act [42 U.S.C. 1395i–2(d)(5)(B)(iii)], as added by subsection (a).”

Effective Date of 1993 Amendment

Puspan. L. 103–66, title XIII, § 13508(span), Aug. 10, 1993, 107 Stat. 580, provided that: “The amendments made by this section [amending this section] shall apply to monthly premiums under section 1818 of the Social Security Act [42 U.S.C. 1395i–2] for months beginning with January 1, 1994.”

Effective Date of 1990 Amendment

Puspan. L. 101–508, title IV, § 4008(g)(2), Nov. 5, 1990, 104 Stat. 1388–46, provided that: “The amendment made by paragraph (1) [amending this section] shall take effect on February 1, 1991.”

Effective Date of 1989 Amendment

Amendment by section 6012(a)(1) of Puspan. L. 101–239 effective Dec. 19, 1989, but not applicable so as to provide coverage under this part for any month before July 1990, see section 6012(span) of Puspan. L. 101–239, set out as an Effective Date note under section 1395i–2a of this title.

Puspan. L. 101–239, title VI, § 6013(c), Dec. 19, 1989, 103 Stat. 2164, provided that: “The amendments made by this section [amending this section and section 1395v of this title] shall become effective January 1, 1990.”

Effective Date of 1988 Amendment

Amendment by Puspan. L. 100–485 effective as if originally included in the Medicare Catastrophic Coverage Act of 1988, Puspan. L. 100–360, see section 608(g)(1) of Puspan. L. 100–485, set out as a note under section 704 of this title.

Amendment by section 103 of Puspan. L. 100–360 effective Jan. 1, 1989, except as otherwise provided, and applicable to inpatient hospital deductible for 1989 and succeeding years, to care and services furnished on or after Jan. 1, 1989, to premiums for January 1989 and succeeding months, and to blood or blood cells furnished on or after Jan. 1, 1989, see section 104(a) of Puspan. L. 100–360, set out as a note under section 1395d of this title.

Except as specifically provided in section 411 of Puspan. L. 100–360, amendment by section 411(span)(8)(D) of Puspan. L. 100–360, as it relates to a provision in the Omnibus Budget Reconciliation Act of 1987, Puspan. L. 100–203, effective as if included in the enactment of that provision in Puspan. L. 100–203, see section 411(a) of Puspan. L. 100–360, set out as a Reference to OBRA; Effective Date note under section 106 of Title 1, General Provisions.

Effective Date of 1986 Amendment

Puspan. L. 99–272, title IX, § 9124(span), Apr. 7, 1986, 100 Stat. 168, provided that:

“(1) The amendment made by subsection (a)(3) [amending this section] shall apply to premiums paid for months beginning with July 1986.

“(2) In applying that amendment, months (before, during, or after April 1986) in which an individual was required to pay a premium increased under the section that was so amended shall be taken into account in determining the month in which the premium will no longer be subject to an increase under that section as so amended.”

Effective Date of 1984 Amendment

Amendment by section 2315(e) of Puspan. L. 98–369 effective as though included in the enactment of the Social Security Amendments of 1983, Puspan. L. 98–21, see section 2315(g) of Puspan. L. 98–369, set out as an Effective and Termination Dates of 1984 Amendments note under section 1395ww of this title.

Amendment by section 2354(span)(3), (4) of Puspan. L. 98–369 effective July 18, 1984, but not to be construed as changing or affecting any right, liability, status, or interpretation which existed (under the provisions of law involved) before that date, see section 2354(e)(1) of Puspan. L. 98–369, set out as a note under section 1320a–1 of this title.

Effective Date of 1983 Amendment; Transitional Rule

Amendment by Puspan. L. 98–21 applicable to premiums for months beginning with January 1984, but for months after June 1983 and before January 1984, the monthly premium for June 1983 shall apply to individuals enrolled under parts A and B of this subchapter, see section 606(c) of Puspan. L. 98–21, set out as a note under section 1395r of this title.

Special Enrollment Provisions for Merchant Seamen

Puspan. L. 97–248, title I, § 125, Sept. 3, 1982, 96 Stat. 365, provided that:

“(a) Any individual who—

“(1) was entitled to medical, surgical, and dental treatment and hospitalization under section 322(a) of the Public Health Service Act [42 U.S.C. 249(a)] (as in effect on September 30, 1981), including such entitlement on the basis of continuing medical care under 42 C.F.R. § 32.17, at any time during the period beginning on March 10, 1981, and ending on October 1, 1981, and

“(2) as of September 30, 1981, was eligible under section 1818(a) or section 1836 of the Social Security Act [42 U.S.C. 1395i–2(a), 1395o] to enroll in the insurance program established by part A or part B, respectively, of title XVIII of that Act [42 U.S.C. 1395c et seq., 1395j et seq.] (hereinafter in this section referred to as the ‘respective program’),

may enroll (if not otherwise enrolled) in the respective program during the period beginning on the first day of the first month beginning at least 20 days after the date of the enactment of this Act [Sept. 3, 1982] and ending on December 31, 1982.

“(span)

(1) The coverage period under the respective program of an individual who enrolls under subsection (a) shall begin—

“(A) on the first day of the month following the month in which the individual enrolls, or

“(B) on October 1, 1981, if the individual files a request for this subparagraph to apply and pays the monthly premiums for the months so covered.

“(2) The coverage period under the respective program of an individual described in subsection (a) who enrolled in the respective program before the enrollment period described in that subsection shall be retroactively extended to October 1, 1981, if the individual files a request before January 1, 1983, for such retroactive extension and pays the monthly premiums for the months so covered.

“(c)

(1) For purposes of section 1839(d) of the Social Security Act [42 U.S.C. 1395r(d)] with respect to the monthly premium for months after September 1981, if an individual described in subsection (a) has enrolled in the insurance program under part B of title XVIII of the Social Security Act [42 U.S.C. 1395j et seq.] at any time before the end of the enrollment period described in subsection (a), any month (before the end of that enrollment period) in which he was not enrolled in that program shall not be treated as a month in which he could have been enrolled in the program.

“(2) Paragraph (1) shall not apply to an individual—

“(A) if the individual has enrolled in the insurance program before March 10, 1981, unless the enrollment was terminated solely because the individual lost eligibility to be so enrolled, or

“(B) unless the individual applies for the benefit of such paragraph before January 1, 1983.

“(d)

(1) The Secretary of Health and Human Services, beginning as soon as possible but not later than 30 days after the date of the enactment of this Act [Sept. 3, 1982], shall provide for the dissemination of information—

“(A) to unions and other associations representing or assisting seamen,

“(B) to offices enrolling individuals under the respective programs, and

“(C) to such other entities and in such a manner as will effectively inform individuals eligible for benefits under this section,

concerning the special benefits provided under this section.

“(2) An individual may establish that the individual was entitled at a date to medical, surgical, and dental treatment and hospitalization under section 322(a) of the Public Health Service Act [42 U.S.C. 249(a)] (as in effect before October 1, 1981) by providing—

“(A) documentation relating to the status under which the individual was provided care in (or under arrangements with) a Public Health Service facility on that date,

“(B) the individual’s seamen’s papers covering that date, or

“(C) such other reasonable documentation as the Secretary may require.”