42 USC 1395 - Eligibility, election, and enrollment

1 See References in Text note below.

and subparagraph (D), at any time during the first 6 months of 2006, or, if the individual first becomes a Medicare+Choice eligible individual during 2006, during the first 6 months during 2006 in which the individual is a Medicare+Choice eligible individual, a Medicare+Choice eligible individual may change the election under subsection (a)(1).

Editorial Notes

References in Text

Subsec. (e)(2)(C), referred to in subsec. (e)(2)(B)(i), was amended generally by section 3204(a)(1) of Puspan. L. 111–148 and, as so amended, no longer contains a cl. (iii).

Amendments

2016—Subsec. (a)(3). Puspan. L. 114–255, § 17006(a)(1), struck out subpar. (A) designation and span, substituted “In this subchapter,” for “In this subchapter, subject to subparagraph (B),”, and struck out subpar. (B), which provided a special rule for end-stage renal disease.

Subsec. (e)(2)(C). Puspan. L. 114–255, § 17005(1), inserted “from 2011 through 2018” after “45-day period” in span and “and ending with 2018” after “beginning with 2011” in text.

Subsec. (e)(2)(G). Puspan. L. 114–255, § 17005(2), added subpar. (G).

Subsec. (i)(3). Puspan. L. 114–255, § 17006(c)(2), added par. (3).

2015—Subsec. (a)(3)(B). Puspan. L. 114–10, § 209(span)(3), inserted concluding provisions.

Subsec. (c)(1). Puspan. L. 114–10, § 209(span)(1)(A), substituted “Subject to paragraph (4), such elections” for “Such elections”.

Subsec. (c)(4). Puspan. L. 114–10, § 209(span)(1)(B), added par. (4).

Subsec. (d)(2)(B). Puspan. L. 114–10, § 209(c), designated existing provisions as cl. (i), inserted span, and added cl. (ii).

Puspan. L. 114–10, § 209(c)(1), which directed the substitution of “Notifications required” for “Notification to newly eligible medicare advantage eligible individuals” in span, was executed by making the substitution for “Notification to newly eligible Medicare+Choice eligible individuals” to reflect the probable intent of Congress.

Subsec. (e)(2)(F). Puspan. L. 114–10, § 209(span)(2)(A), added subpar. (F).

Subsec. (e)(6)(A). Puspan. L. 114–10, § 209(span)(2)(B)(i), substituted “paragraph (1), during the period described in paragraph (2)(F),” for “paragraph (1),”.

2010—Subsec. (span)(1)(C). Puspan. L. 111–148, § 3201(e)(2)(A)(i), which directed that subpar. (C) be struck out, was repealed by Puspan. L. 111–152, § 1102(a). See Effective Date of 2010 Amendment note below.

Subsec. (e)(2)(C). Puspan. L. 111–148, § 3204(a)(1), amended subpar. (C) generally. Prior to amendment, subpar. (C) related to continuous open enrollment and disenrollment for first 3 months of a year after 2006.

Subsec. (e)(3)(B)(iv). Puspan. L. 111–148, § 3204(span)(2)(A), substituted “, 2008, 2009, and 2010” for “and succeeding years”.

Subsec. (e)(3)(B)(v). Puspan. L. 111–148, § 3204(span)(1), (2)(B), (3), added cl. (v).

2009—Subsec. (i)(1). Puspan. L. 111–5 substituted “1395ww(h)(3)(D), and 1395w–23(m)” for “and 1395ww(h)(3)(D)”.

2008—Subsec. (h)(4)(A). Puspan. L. 110–275, § 103(a)(1)(A)(i)(I)(aa), substituted “, subject to subsection (j)(2)(C), cash, gifts, prizes, or other monetary rebates” for “cash or other monetary rebates”.

Subsec. (h)(4)(C). Puspan. L. 110–275, § 103(a)(1)(A)(i)(I)(bspan)–(III), added subpar. (C).

Subsec. (h)(4)(D). Puspan. L. 110–275, § 103(span)(1)(A), added subpar. (D).

Subsec. (h)(6). Puspan. L. 110–275, § 103(c)(1), added par. (6).

Subsec. (h)(7). Puspan. L. 110–275, § 103(d)(1), added par. (7).

Subsec. (j). Puspan. L. 110–275, § 103(a)(1)(A)(ii), added subsec. (j).

Subsec. (j)(2). Puspan. L. 110–275, § 103(span)(1)(B), added par. (2).

2007—Subsec. (e)(2)(E)(i). Puspan. L. 110–48, § 2(1), substituted “the period beginning on January 1, 2007, and ending on July 31, 2007,” for “2007 or 2008”.

Subsec. (e)(2)(E)(iii). Puspan. L. 110–48, § 2(2), substituted “the applicable period” for “year” in span and “the period described in such clause” for “the year” in text.

2006—Subsec. (e)(2)(E). Puspan. L. 109–432 added subpar. (E).

2003—Subsec. (a)(1). Puspan. L. 108–173, § 102(c)(1)(A), (C), inserted “(other than qualified prescription drug benefits)” after “benefits” in introductory provisions and inserted concluding provisions.

Subsec. (a)(1)(B). Puspan. L. 108–173, § 102(c)(1)(B), substituted comma for period at end.

Subsec. (a)(2)(A). Puspan. L. 108–173, § 221(a)(1), substituted “Coordinated care plans (including regional plans)” for “Coordinated care plans” in span, inserted cl. (i) designation and span before “Coordinated”, and inserted “regional or local” before “preferred provider organization plans” and “(including MA regional plans)” before period at end.

Subsec. (a)(2)(A)(ii). Puspan. L. 108–173, § 231(a), added cl. (ii).

Subsec. (a)(3)(B)(ii). Puspan. L. 108–173, § 222(l)(3)(D), made technical amendment to reference in original act which appears in text as reference to subsection (e)(4)(A) of this section.

Subsec. (span)(1)(B). Puspan. L. 108–173, § 222(l)(3)(A)(i), (ii), substituted “an MA local plan” for “a plan” and “benefits under the original medicare fee-for-service program option” for “basic benefits described in section 1395w–22(a)(1)(A) of this title”.

Subsec. (span)(1)(C). Puspan. L. 108–173, § 222(l)(3)(A)(iii), substituted “in an MA local plan” for “in a Medicare+Choice plan” in introductory provisions.

Subsec. (span)(4). Puspan. L. 108–173, § 233(span)(1), struck out “on a demonstration basis” after “plans” in span.

Subsec. (span)(4)(A). Puspan. L. 108–173, § 233(span)(2), struck out first sentence which read as follows: “An individual is not eligible to enroll in an MSA plan under this part—

“(i) on or after January 1, 2003, unless the enrollment is the continuation of such an enrollment in effect as of such date; or

“(ii) as of any date if the number of such individuals so enrolled as of such date has reached 390,000.”

Subsec. (span)(4)(C). Puspan. L. 108–173, § 233(span)(3), struck out at end “The Secretary shall submit such a report, by not later than March 1, 2002, on whether the time limitation under subparagraph (A)(i) should be extended or removed and whether to change the numerical limitation under subparagraph (A)(ii).”

Subsec. (d)(3)(F). Puspan. L. 108–173, § 222(l)(3)(B)(i), added subpar. (F).

Subsec. (d)(4)(A)(ii). Puspan. L. 108–173, § 222(l)(3)(B)(ii), inserted “, including information on the single deductible (if applicable) under section 1395w–27a(span)(1) of this title” after “cost sharing”.

Subsec. (d)(4)(B)(i). Puspan. L. 108–173, § 222(l)(3)(B)(iii), substituted “monthly amount of the premium charged to an individual” for “Medicare+Choice monthly basic beneficiary premium and Medicare+Choice monthly supplemental beneficiary premium, if any, for the plan or, in the case of an MSA plan, the Medicare+Choice monthly MSA premium”.

Subsec. (d)(4)(E). Puspan. L. 108–173, § 222(l)(3)(B)(iv), reenacted span without change and amended text generally. Prior to amendment, text read as follows: “Whether the organization offering the plan includes mandatory supplemental benefits in its base benefit package or offers optional supplemental benefits and the terms and conditions (including premiums) for such coverage.”

Subsec. (e)(1). Puspan. L. 108–173, § 102(a)(4), inserted at end “If any portion of an individual’s initial enrollment period under part B occurs after the end of the annual, coordinated election period described in paragraph (3)(B)(iii), the initial enrollment period under this part shall further extend through the end of the individual’s initial enrollment period under part B.”

Subsec. (e)(2). Puspan. L. 108–173, § 102(a)(1)(A), substituted “2005” and “2006” for “2004” and “2005”, respectively, wherever appearing.

Subsec. (e)(2)(B)(i). Puspan. L. 108–173, § 102(a)(6)(A), inserted “, subparagraph (C)(iii),” after “clause (ii)”.

Subsec. (e)(2)(C)(i). Puspan. L. 108–173, § 102(a)(6)(B), substituted “clauses (ii) and (iii)” for “clause (ii)”.

Subsec. (e)(2)(C)(iii). Puspan. L. 108–173, § 102(a)(6)(C), added cl. (iii).

Subsec. (e)(3)(B). Puspan. L. 108–173, § 102(a)(2), reenacted span without change and amended text generally. Prior to amendment, text read as follows: “For purposes of this section, the term ‘annual, coordinated election period’ means, with respect to a year before 2003 and after 2005, the month of November before such year and with respect to 2003, 2004, and 2005, the period beginning on November 15 and ending on December 31 of the year before such year.”

Subsec. (e)(3)(C). Puspan. L. 108–173, § 102(a)(3)(A), inserted “and during the period described in subparagraph (B)(iii)” after “(beginning with 1999)”.

Subsec. (e)(3)(D). Puspan. L. 108–173, § 102(a)(3)(B), in span, substituted “campaigns” for “campaign in 1998” and, in text, inserted at end “During the period described in subparagraph (B)(iii), the Secretary shall provide for an educational and publicity campaign to inform MA eligible individuals about the availability of MA plans (including MA–PD plans) offered in different areas and the election process provided under this section.”

Subsec. (e)(4). Puspan. L. 108–173, § 102(a)(1)(B), substituted “2006” for “2005” in two places.

Subsec. (e)(5)(A)(i). Puspan. L. 108–173, § 233(d)(1), inserted “or” at end.

Subsec. (e)(5)(A)(ii). Puspan. L. 108–173, § 233(d)(2), substituted semicolon for “, or”.

Subsec. (e)(5)(A)(iii). Puspan. L. 108–173, § 233(d)(3), struck out cl. (iii) which read as follows: “the month of November 1998;”.

Subsec. (f)(1). Puspan. L. 108–173, § 222(l)(3)(E), substituted “subsection (e)(1)” for “subsection (e)(1)(A)”.

Subsec. (f)(3). Puspan. L. 108–173, § 102(a)(5), inserted “, other than the period described in clause (iii) of such subsection” after “subsection (e)(3)(B)”.

Subsec. (i)(1). Puspan. L. 108–173, § 237(span)(2)(A)(i), inserted “1395w–23(a)(4),” after “Subject to sections 1395w–22(a)(5),”.

Subsec. (i)(2). Puspan. L. 108–173, § 237(span)(2)(A)(ii), inserted “1395w–23(a)(4),” after “Subject to sections”.

Puspan. L. 108–173, § 221(d)(5), inserted “1395w–27a(h),” after “1395w–27(f)(2),”.

2002—Subsec. (e)(2)(A). Puspan. L. 107–188, § 532(a)(1), substituted “through 2004” for “through 2001” in span and “during the period beginning January 1, 1998, and ending on December 31, 2004” for “during 1998, 1999, 2000, and 2001” in text.

Subsec. (e)(2)(B). Puspan. L. 107–188, § 532(a)(2), substituted “during 2005” for “during 2002” in span.

Subsec. (e)(2)(B)(i), (C)(i). Puspan. L. 107–188, § 532(a)(3), substituted “2005” for “2002” wherever appearing.

Subsec. (e)(2)(D). Puspan. L. 107–188, § 532(a)(4), substituted “2004” for “2001”.

Subsec. (e)(3)(B). Puspan. L. 107–188, § 532(c)(1)(A), substituted “means, with respect to a year before 2003 and after 2005, the month of November before such year and with respect to 2003, 2004, and 2005, the period beginning on November 15 and ending on December 31 of the year before such year” for “means, with respect to a calendar year (beginning with 2000), the month of November before such year”.

Subsec. (e)(4). Puspan. L. 107–188, § 532(a)(5), substituted “2005” for “2002” in introductory and concluding provisions.

Subsec. (e)(6)(A). Puspan. L. 107–188, § 532(c)(1)(B), substituted “during the annual, coordinated election period under paragraph (3) for each subsequent year” for “each subsequent year (as provided in paragraph (3))”.

2000—Subsec. (a)(3)(B). Puspan. L. 106–554, § 1(a)(6) [title VI, § 620(a)], substituted “except that—” and cls. (i) and (ii) for “except that an individual who develops end-stage renal disease while enrolled in a Medicare+Choice plan may continue to be enrolled in that plan.”

Subsec. (d)(4)(B). Puspan. L. 106–554, § 1(a)(6) [title VI, § 606(a)(2)(C)], designated existing provisions as cl. (i), inserted span, and added cl. (ii).

Subsec. (f)(2). Puspan. L. 106–554, § 1(a)(6) [title VI, § 619(a)], struck out “, except that if such election or change is made after the 10th day of any calendar month, then the election or change shall not take effect until the first day of the second calendar month following the date on which the election or change is made” before period at end.

Subsec. (h)(1)(A). Puspan. L. 106–554, § 1(a)(6) [title VI, § 613(a)(1)], inserted “(or 10 days in the case described in paragraph (5))” after “45 days”.

Subsec. (h)(5). Puspan. L. 106–554, § 1(a)(6) [title VI, § 613(a)(2)], added par. (5).

1999—Subsec. (span)(1)(A). Puspan. L. 106–113, § 1000(a)(6) [title V, § 501(c)(1)], inserted “and except as provided in subparagraph (C)” after “may otherwise provide”.

Subsec. (span)(1)(C). Puspan. L. 106–113, § 1000(a)(6) [title V, § 501(c)(2)], added subpar. (C).

Subsec. (e)(2)(B)(i). Puspan. L. 106–113, § 1000(a)(6) [title V, § 501(span)(1)], inserted “and subparagraph (D)” after “clause (ii)”.

Subsec. (e)(2)(C)(i). Puspan. L. 106–113, § 1000(a)(6) [title V, § 501(span)(2)], inserted “and subparagraph (D)” after “clause (ii)”.

Subsec. (e)(2)(D). Puspan. L. 106–113, § 1000(a)(6) [title V, § 501(span)(3)], added subpar. (D).

Subsec. (e)(3)(C). Puspan. L. 106–113, § 1000(a)(6) [title V, § 519(a)], substituted “During the fall season” for “In the month of November”.

Subsec. (e)(4)(A). Puspan. L. 106–113, § 1000(a)(6) [title V, § 501(a)(1)], added subpar. (A) and struck out former subpar. (A) which read as follows: “the organization’s or plan’s certification under this part has been terminated or the organization has terminated or otherwise discontinued providing the plan in the area in which the individual resides;”.

Subsec. (f)(2). Puspan. L. 106–113, § 1000(a)(6) [title V, § 502(a)], inserted “or change” before “is made” and “, except that if such election or change is made after the 10th day of any calendar month, then the election or change shall not take effect until the first day of the second calendar month following the date on which the election or change is made” before the period at end.

Subsec. (i)(2). Puspan. L. 106–113, § 1000(a)(6) [title III, § 321(k)(6)(A)], struck out “and” after “1395w–27(f)(2),”.

Statutory Notes and Related Subsidiaries

Effective Date of 2016 Amendment

Puspan. L. 114–255, div. C, title XVII, § 17006(a)(3), Dec. 13, 2016, 130 Stat. 1334, provided that: “The amendments made by this subsection [amending this section and sections 1395w–22 and 1395w–28 of this title] shall apply with respect to plan years beginning on or after January 1, 2021.”

Puspan. L. 114–255, div. C, title XVII, § 17006(c)(3), Dec. 13, 2016, 130 Stat. 1335, provided that: “The amendments made by this subsection [amending this section and section 1395w–22 of this title] shall apply with respect to plan years beginning on or after January 1, 2021.”

Effective Date of 2010 Amendment

Puspan. L. 111–152, title I, § 1102(a), Mar. 30, 2010, 124 Stat. 1040, provided that sections 3201 (amending this section and sections 1395w–23, 1395w–24, 1395w–27a, 1395w–29, and 1395eee of this title and enacting provisions set out as notes under this section and section 1395w–24 of this title) and 3203 (amending section 1395w–23 of this title) of Puspan. L. 111–148, and the amendments made by such sections, were repealed, effective as if included in the enactment of Puspan. L. 111–148.

Puspan. L. 111–148, title III, § 3201(e)(2)(B), Mar. 23, 2010, 124 Stat. 447, which provided that amendments by section 3201(e)(2) of Puspan. L. 111–148 (amending this section and sections 1395w–23 and 1395w–24 of this title) would take effect on Jan. 1, 2012, was repealed by Puspan. L. 111–152, title I, § 1102(a), Mar. 30, 2010, 124 Stat. 1040, effective as if included in the enactment of Puspan. L. 111–148.

Puspan. L. 111–148, title III, § 3204(a)(2), Mar. 23, 2010, 124 Stat. 456, provided that: “The amendment made by paragraph (1) [amending this section] shall apply with respect to 2011 and succeeding years.”

Effective Date of 2008 Amendment

Puspan. L. 110–275, title I, § 103(a)(3), July 15, 2008, 122 Stat. 2499, provided that: “The amendments made by this subsection [amending this section and section 1395w–104 of this title] shall apply to plan years beginning on or after January 1, 2009.”

Puspan. L. 110–275, title I, § 103(span)(3), July 15, 2008, 122 Stat. 2500, provided that: “The amendments made by this subsection [amending this section and section 1395w–104 of this title] shall take effect on a date specified by the Secretary (but in no case later than November 15, 2008).”

Puspan. L. 110–275, title I, § 103(d)(3), July 15, 2008, 122 Stat. 2501, provided that: “The amendments made by this subsection [amending this section and section 1395w–104 of this title] shall apply to plan years beginning on or after January 1, 2009.”

Effective Date of 2003 Amendment

Puspan. L. 108–173, title I, § 102(c)(2), Dec. 8, 2003, 117 Stat. 2154, provided that: “The amendments made by this subsection [amending this section] shall apply on and after January 1, 2006.”

Puspan. L. 108–173, title II, § 223(a), Dec. 8, 2003, 117 Stat. 2207, provided that: “The amendments made by this subtitle [subtitle C (§§ 221–223) of title II of Puspan. L. 108–173, enacting section 1395w–27a of this title and amending this section and sections 1395r, 1395s, 1395w, 1395w–22 to 1395w–24, 1395w–27, and 1395w–28 of this title] shall apply with respect to plan years beginning on or after January 1, 2006.”

Puspan. L. 108–173, title II, § 231(f)(1), Dec. 8, 2003, 117 Stat. 2208, provided that: “The amendments made by subsections (a), (span), and (c) [amending this section and section 1395w–28 of this title] shall take effect upon the date of the enactment of this Act [Dec. 8, 2003].”

Amendment by section 237(span)(2)(A) of Puspan. L. 108–173 applicable to services provided on or after Jan. 1, 2006, and contract years beginning on or after such date, see section 237(e) of Puspan. L. 108–173, set out as a note under section 1320a–7span of this title.

Effective Date of 2002 Amendment

Puspan. L. 107–188, title V, § 532(c)(2), June 12, 2002, 116 Stat. 696, provided that: “The amendment made by paragraph (1) [amending this section] shall apply to the annual, coordinated election period for years beginning with 2003.”

Effective Date of 2000 Amendment

Amendment by section 1(a)(6) [title VI, § 606(a)(2)(C)] of Puspan. L. 106–554 applicable to years beginning with 2003, see section 1(a)(6) [title VI, § 606(span)] of Puspan. L. 106–554, set out as a note under section 1395r of this title.

Puspan. L. 106–554, § 1(a)(6) [title VI, § 613(span)], Dec. 21, 2000, 114 Stat. 2763, 2763A–560, provided that: “The amendments made by subsection (a) [amending this section] shall apply to marketing material submitted on or after January 1, 2001.”

Puspan. L. 106–554, § 1(a)(6) [title VI, § 619(span)], Dec. 21, 2000, 114 Stat. 2763, 2763A–563, provided that: “The amendment made by this section [amending this section] shall apply to elections and changes of coverage made on or after June 1, 2001.”

Puspan. L. 106–554, § 1(a)(6) [title VI, § 620(span)], Dec. 21, 2000, 114 Stat. 2763, 2763A–564, provided that:

“(1)In general.—The amendment made by subsection (a) [amending this section] shall apply to terminations and discontinuations occurring on or after the date of the enactment of this Act [Dec. 21, 2000].

“(2)Application to prior plan terminations.—Clause (ii) of section 1851(a)(3)(B) of the Social Security Act [42 U.S.C. 1395w–21(a)(3)(B)(ii)] (as inserted by subsection (a)) shall also apply to individuals whose enrollment in a Medicare+Choice plan was terminated or discontinued after December 31, 1998, and before the date of the enactment of this Act. In applying this paragraph, such an individual shall be treated, for purposes of part C of title XVIII of the Social Security Act [42 U.S.C. 1395w–21 et seq.], as having discontinued enrollment in such a plan as of the date of the enactment of this Act.”

Effective Date of 1999 Amendment

Amendment by section 1000(a)(6) [title III, § 321(k)(6)(A)] of Puspan. L. 106–113 effective as if included in the enactment of the Balanced Budget Act of 1997, Puspan. L. 105–33, except as otherwise provided, see section 1000(a)(6) [title III, § 321(m)] of Puspan. L. 106–113, set out as a note under section 1395d of this title.

Puspan. L. 106–113, div. B, § 1000(a)(6) [title V, § 501(d)], Nov. 29, 1999, 113 Stat. 1536, 1501A–379, provided that:

“(1) The amendments made by subsection (a) [amending this section and section 1395ss of this title] apply to notices of impending terminations or discontinuances made on or after the date of the enactment of this Act [Nov. 29, 1999].

“(2) The amendments made by subsection (c) [amending this section] apply to elections made on or after the date of the enactment of this Act [Nov. 29, 1999] with respect to eliminations of Medicare+Choice payment areas from a service area that occur before, on, or after the date of the enactment of this Act.”

Puspan. L. 106–113, div. B, § 1000(a)(6) [title V, § 502(span)], Nov. 29, 1999, 113 Stat. 1536, 1501A–380, provided that: “The amendments made by this section [amending this section] apply to elections and changes of coverage made on or after January 1, 2000.”

Puspan. L. 106–113, div. B, § 1000(a)(6) [title V, § 519(span)], Nov. 29, 1999, 113 Stat. 1536, 1501A–385, provided that: “The amendment made by subsection (a) [amending this section] first applies to campaigns conducted beginning in 2000.”

Regulations

Puspan. L. 108–173, title II, § 223(span), Dec. 8, 2003, 117 Stat. 2207, provided that: “The Secretary [of Health and Human Services] shall revise the regulations previously promulgated to carry out part C of title XVIII of the Social Security Act [42 U.S.C. 1395w–21 et seq.] to carry out the provisions of this Act [see Tables for classification].”

Construction

Puspan. L. 108–173, title II, § 221(span)(2), Dec. 8, 2003, 117 Stat. 2181, provided that: “Nothing in part C of title XVIII of the Social Security Act [42 U.S.C. 1395w–21 et seq.] shall be construed as preventing an MSA plan or MA private fee-for-service plan from having a service area that covers one or more MA regions or the entire nation.”

No Cuts in Guaranteed Benefits

Puspan. L. 111–148, title III, § 3602, Mar. 23, 2010, 124 Stat. 538, provided that: “Nothing in this Act [see Short Title note set out under section 18001 of this title] shall result in the reduction or elimination of any benefits guaranteed by law to participants in Medicare Advantage plans.”

Implementation of Medicare Advantage Program

Puspan. L. 108–173, title II, § 201, Dec. 8, 2003, 117 Stat. 2176, provided that:

“(a)In General.—There is hereby established the Medicare Advantage program. The Medicare Advantage program shall consist of the program under part C of title XVIII of the Social Security Act [42 U.S.C. 1395w–21 et seq.] (as amended by this Act [see Tables for classification]).

“(span)References.—Subject to subsection (c), any reference to the program under part C of title XVIII of the Social Security Act [42 U.S.C. 1395w–21 et seq.] shall be deemed a reference to the Medicare Advantage program and, with respect to such part, any reference to ‘Medicare+Choice’ is deemed a reference to ‘Medicare Advantage’ and ‘MA’.

“(c)Transition.—In order to provide for an orderly transition and avoid beneficiary and provider confusion, the Secretary [of Health and Human Services] shall provide for an appropriate transition in the use of the terms ‘Medicare+Choice’ and ‘Medicare Advantage’ (or ‘MA’) in reference to the program under part C of title XVIII of the Social Security Act [42 U.S.C. 1395w–21 et seq.]. Such transition shall be fully completed for all materials for plan years beginning not later than January 1, 2006. Before the completion of such transition, any reference to ‘Medicare Advantage’ or ‘MA’ shall be deemed to include a reference to ‘Medicare+Choice’.”

Report on Impact of Increased Financial Assistance to Medicare Advantage Plans

Puspan. L. 108–173, title II, § 211(g), Dec. 8, 2003, 117 Stat. 2178, directed the Secretary of Health and Human Services to submit to Congress, not later than July 1, 2006, a report that described the impact of additional financing provided under Puspan. L. 108–173 and other Acts on the availability of Medicare Advantage plans in different areas and its impact on lowering premiums and increasing benefits under such plans.

MedPAC Study and Report on Clarification of Authority Regarding Disapproval of Unreasonable Beneficiary Cost-Sharing

Puspan. L. 108–173, title II, § 211(h), Dec. 8, 2003, 117 Stat. 2179, directed the Medicare Payment Advisory Commission, in consultation with beneficiaries, consumer groups, employers, and organizations offering plans under this part, to conduct a study to determine the extent to which the cost-sharing structures under such plans affect access to covered services or select enrollees based on the health status of eligible individuals described in subsection (a)(3) of this section, and to submit a report to Congress on such study not later than Dec. 31, 2004.

Moratorium on New Local Preferred Provider Organization Plans

Puspan. L. 108–173, title II, § 221(a)(2), Dec. 8, 2003, 117 Stat. 2180, directed the Secretary of Health and Human Services not to permit the offering of a local preferred provider organization plan under this part during 2006 or 2007 in a service area unless such plan was offered under this part (including under a demonstration project under this part) in such area as of Dec. 31, 2005.

Specialized MA Plans

Puspan. L. 110–275, title I, § 164(span), July 15, 2008, 122 Stat. 2571, provided that: “During the period beginning on January 1, 2010, and ending on December 31, 2010, the Secretary of Health and Human Services may not exercise the authority provided under section 231(d) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 [Puspan. L. 108–173] (42 U.S.C. 1395w–21 note) to designate other plans as specialized MA plans for special needs individuals.”

Puspan. L. 110–173, title I, § 108(span), Dec. 29, 2007, 121 Stat. 2496, provided that:

“(1)Authority to designate other plans as specialized ma plans.—During the period beginning on January 1, 2008, and ending on December 31, 2009, the Secretary of Health and Human Services shall not exercise the authority provided under section 231(d) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 [Puspan. L. 108–173] (42 U.S.C. 1395w–21 note) to designate other plans as specialized MA plans for special needs individuals under part C of title XVIII of the Social Security Act [42 U.S.C. 1395w–21 et seq.]. The preceding sentence shall not apply to plans designated as specialized MA plans for special needs individuals under such authority prior to January 1, 2008.

“(2)Enrollment in new plans.—During the period beginning on January 1, 2008, and ending on December 31, 2009, the Secretary of Health and Human Services shall not permit enrollment of any individual residing in an area in a specialized Medicare Advantage plan for special needs individuals under part C of title XVIII of the Social Security Act to take effect unless that specialized Medicare Advantage plan for special needs individuals was available for enrollment for individuals residing in that area on January 1, 2008.”

Puspan. L. 108–173, title II, § 231(d), Dec. 8, 2003, 117 Stat. 2208, provided that: “In promulgating regulations to carry out section 1851(a)(2)(A)(ii) of the Social Security Act [42 U.S.C. 1395w–21(a)(2)(A)(ii)] (as added by subsection (a)) and section 1859(span)(6) of such Act [42 U.S.C. 1395w–28(span)(6)] (as added by subsection (span)), the Secretary [of Health and Human Services] may provide (notwithstanding section 1859(span)(6)(A) of such Act) for the offering of specialized MA plans for special needs individuals by MA plans that disproportionately serve special needs individuals.”

Puspan. L. 108–173, title II, § 231(e), Dec. 8, 2003, 117 Stat. 2208, provided that: “Not later than December 31, 2007, the Secretary [of Health and Human Services] shall submit to Congress a report that assesses the impact of specialized MA plans for special needs individuals on the cost and quality of services provided to enrollees. Such report shall include an assessment of the costs and savings to the medicare program as a result of amendments made by subsections (a), (span), and (c) [amending this section and section 1395w–28 of this title].”

MedPAC Study on Consumer Coalitions

Puspan. L. 106–554, § 1(a)(6) [title I, § 124], Dec. 21, 2000, 114 Stat. 2763, 2763A–478, directed the Medicare Payment Advisory Commission to conduct a study examining the use of consumer coalitions in the marketing of Medicare+Choice plans under the medicare program under this subchapter and to submit a report on the study to Congress no later than 1 year after Dec. 21, 2000.

Report on Accounting for VA and DOD Expenditures for Medicare Beneficiaries

Puspan. L. 106–113, div. B, § 1000(a)(6) [title V, § 551], Nov. 29, 1999, 113 Stat. 1536, 1501A–392, directed the Secretary of Health and Human Services, jointly with the Secretaries of Defense and of Veterans Affairs, to submit to Congress, no later than Apr. 1, 2001, a report on the estimated use of health care services furnished by the Departments of Defense and of Veterans Affairs to medicare beneficiaries.

Report on Medicare MSA (Medical Savings Account) Plans

Puspan. L. 106–113, div. B, § 1000(a)(6) [title V, § 552(span)], Nov. 29, 1999, 113 Stat. 1536, 1501A–393, directed the Medicare Payment Assessment Commission to submit to Congress, no later than 1 year after Nov. 29, 1999, a report on specific legislative changes that should be made to make MSA plans a viable option under the Medicare+Choice program.

GAO Audit and Reports on Provision of Medicare+Choice Health Information to Beneficiaries

Puspan. L. 106–113, div. B, § 1000(a)(6) [title V, § 553(span)], Nov. 29, 1999, 113 Stat. 1536, 1501A–393, provided that:

“(1)In general.—Beginning in 2000, the Comptroller General shall conduct an annual audit of the expenditures by the Secretary of Health and Human Services during the preceding year in providing information regarding the Medicare+Choice program under part C of title XVIII of the Social Security Act (42 U.S.C. 1395w–21 et seq.) to eligible medicare beneficiaries.

“(3) [(2)]Reports.—Not later than March 31 of 2001, 2004, 2007, and 2010, the Comptroller General shall submit a report to Congress on the results of the audit of the expenditures of the preceding 3 years conducted pursuant to subsection (a) [enacting provisions set out as a note under section 1395ss of this title], together with an evaluation of the effectiveness of the means used by the Secretary of Health and Human Services in providing information regarding the Medicare+Choice program under part C of title XVIII of the Social Security Act (42 U.S.C. 1395w–21 et seq.) to eligible medicare beneficiaries.”

Enrollment Transition Rule

Puspan. L. 105–33, title IV, § 4002(c), Aug. 5, 1997, 111 Stat. 329, provided that: “An individual who is enrolled on December 31, 1998, with an eligible organization under section 1876 of the Social Security Act (42 U.S.C. 1395mm) shall be considered to be enrolled with that organization on January 1, 1999, under part C of title XVIII of such Act [42 U.S.C. 1395w–21 et seq.] if that organization has a contract under that part for providing services on January 1, 1999 (unless the individual has disenrolled effective on that date).”

Secretarial Submission of Legislative Proposal

Puspan. L. 105–33, title IV, § 4002(f)(2), Aug. 5, 1997, 111 Stat. 330, directed the Secretary of Health and Human Services to submit to Congress, no later than 6 months after Aug. 5, 1997, proposed technical and conforming amendments in the law as required by the provisions of chapter 1 (§§ 4001–4006) of subtitle A of title IV of Puspan. L. 105–33.

Report on Integration and Transition

Puspan. L. 105–33, title IV, § 4014(c), Aug. 5, 1997, 111 Stat. 337, directed the Secretary of Health and Human Services to submit to Congress, no later than Jan. 1, 1999, a plan which provided for the integration of health plans offered by social health maintenance organizations and similar plans as an option under the Medicare+Choice program under this part, for a transition for such organizations operating under demonstration project authority, and for appropriate payment levels for plans offered by such organizations.

Medicare Enrollment Demonstration Project

Puspan. L. 105–33, title IV, § 4018, Aug. 5, 1997, 111 Stat. 346, provided that:

“(a)Demonstration Project.—

“(1)Establishment.—The Secretary shall implement a demonstration project (in this section referred to as the ‘project’) for the purpose of evaluating the use of a third-party contractor to conduct the Medicare+Choice plan enrollment and disenrollment functions, as described in part C of title XVIII of the Social Security Act [42 U.S.C. 1395w–21 et seq.] (as added by section 4001 of this Act), in an area.

“(2)Consultation.—Before implementing the project under this section, the Secretary shall consult with affected parties on—

“(A) the design of the project;

“(B) the selection criteria for the third-party contractor; and

“(C) the establishment of performance standards, as described in paragraph (3).

“(3)Performance standards.—

“(A)In general.—The Secretary shall establish performance standards for the accuracy and timeliness of the Medicare+Choice plan enrollment and disenrollment functions performed by the third-party contractor.

“(B)Noncompliance.—In the event that the third-party contractor is not in substantial compliance with the performance standards established under subparagraph (A), such enrollment and disenrollment functions shall be performed by the Medicare+Choice plan until the Secretary appoints a new third-party contractor.

“(span)Report to Congress.—The Secretary shall periodically report to Congress on the progress of the project conducted pursuant to this section.

“(c)Waiver Authority.—The Secretary shall waive compliance with the requirements of part C of title XVIII of the Social Security Act [42 U.S.C. 1395w–21 et seq.] (as amended by section 4001 of this Act) to such extent and for such period as the Secretary determines is necessary to conduct the project.

“(d)Duration.—A demonstration project under this section shall be conducted for a 3-year period.

“(e)Separate From Other Demonstration Projects.—A project implemented by the Secretary under this section shall not be conducted in conjunction with any other demonstration project.”