United States Code (Last Updated: May 24, 2014) |
Title 42. THE PUBLIC HEALTH AND WELFARE |
Chapter 7. SOCIAL SECURITY |
SubChapter XVIII. HEALTH INSURANCE FOR AGED AND DISABLED |
Part B. Supplementary Medical Insurance Benefits for Aged and Disabled |
§ 1395q. Coverage period
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(a) Commencement The period during which an individual is entitled to benefits under the insurance program established by this part (hereinafter referred to as his “coverage period”) shall begin on whichever of the following is the latest: (1) July 1, 1966 , or (in the case of a disabled individual who has not attained age 65)July 1, 1973 ; or(2) (A) in the case of an individual who enrolls pursuant to subsection (d) of section 1395p of this title before the month in which he first satisfies paragraph (1) or (2) of section 1395o of this title, the first day of such month, or (B) in the case of an individual who enrolls pursuant to such subsection (d) in the month in which he first satisfies such paragraph, the first day of the month following the month in which he so enrolls, or (C) in the case of an individual who enrolls pursuant to such subsection (d) in the month following the month in which he first satisfies such paragraph, the first day of the second month following the month in which he so enrolls, or (D) in the case of an individual who enrolls pursuant to such subsection (d) more than one month following the month in which he satisfies such paragraph, the first day of the third month following the month in which he so enrolls, or (E) in the case of an individual who enrolls pursuant to subsection (e) of section 1395p of this title, the July 1 following the month in which he so enrolls; or (3) (A) in the case of an individual who is deemed to have enrolled on or before the last day of the third month of his initial enrollment period, the first day of the month in which he first meets the applicable requirements of section 1395o of this title or July 1, 1973 , whichever is later, or(B) in the case of an individual who is deemed to have enrolled on or after the first day of the fourth month of his initial enrollment period, as prescribed under subparagraphs (B), (C), (D), and (E) of paragraph (2) of this subsection. (b) Continuation An individual’s coverage period shall continue until his enrollment has been terminated— (1) by the filing of notice that the individual no longer wishes to participate in the insurance program established by this part, or (2) for nonpayment of premiums. The termination of a coverage period under paragraph (1) shall (except as otherwise provided in section 1395v(e) of this title) take effect at the close of the month following the month in which the notice is filed. The termination of a coverage period under paragraph (2) shall take effect on a date determined under regulations, which may be determined so as to provide a grace period in which overdue premiums may be paid and coverage continued. The grace period determined under the preceding sentence shall not exceed 90 days; except that it may be extended to not to exceed 180 days in any case where the Secretary determines that there was good cause for failure to pay the overdue premiums within such 90-day period. Where an individual who is deemed to have enrolled for medical insurance pursuant to section 1395p(f) of this title files a notice before the first day of the month in which his coverage period begins advising that he does not wish to be so enrolled, the termination of the coverage period resulting from such deemed enrollment shall take effect with the first day of the month the coverage would have been effective. Where an individual who is deemed enrolled for medical insurance benefits pursuant to section 1395p(f) of this title files a notice requesting termination of his deemed coverage in or after the month in which such coverage becomes effective, the termination of such coverage shall take effect at the close of the month following the month in which the notice is filed. (c) Termination In the case of an individual satisfying paragraph (1) of section 1395o of this title whose entitlement to hospital insurance benefits under part A of this subchapter is based on a disability rather than on his having attained the age of 65, his coverage period (and his enrollment under this part) shall be terminated as of the close of the last month for which he is entitled to hospital insurance benefits.
(d) Payment of expenses incurred during coverage period No payments may be made under this part with respect to the expenses of an individual unless such expenses were incurred by such individual during a period which, with respect to him, is a coverage period.
(e) Commencement of coverage for special enrollment periods Notwithstanding subsection (a) of this section, in the case of an individual who enrolls during a special enrollment period pursuant to section 1395p(i)(3) or 1395p(i)(4)(B) of this title— (1) in any month of the special enrollment period in which the individual is at any time enrolled in a plan (specified in subparagraph (A) or (B), as applicable, of section 1395p(i)(3) of this title or specified in section 1395p(i)(4)(A)(i) of this title) or in the first month following such a month, the coverage period shall begin on the first day of the month in which the individual so enrolls (or, at the option of the individual, on the first day of any of the following three months), or (2) in any other month of the special enrollment period, the coverage period shall begin on the first day of the month following the month in which the individual so enrolls. (f) Commencement of coverage for certain volunteers serving outside United States Notwithstanding subsection (a), in the case of an individual who enrolls during a special enrollment period pursuant to section 1395p(k) of this title, the coverage period shall begin on the first day of the month following the month in which the individual so enrolls.
Amendments
2006—Subsec. (f). Pub. L. 109–171 added subsec. (f).
2003—Subsec. (a)(1). Pub. L. 108–173 inserted comma after “1966”.
1997—Subsec. (e). Pub. L. 105–33 inserted “or 1395p(i)(4)(B)” after “1395p(i)(3)” in introductory provisions and “or specified in section 1395p(i)(4)(A)(i) of this title” after “1395p(i)(3) of this title” in par. (1).
1994—Subsec. (e). Pub. L. 103–432 amended pars. (1) and (2) generally. Prior to amendment, pars. (1) and (2) read as follows:
“(1) in the first month of the special enrollment period, the coverage period shall begin on the first day of that month, or
“(2) in a month after the first month of the special enrollment period, the coverage period shall begin on the first day of the month following the month in which the individual so enrolls.”
1986—Subsec. (b). Pub. L. 99–509 substituted “month following the month” for “calendar quarter following the calendar quarter” in second and sixth sentences.
Subsec. (e). Pub. L. 99–272 amended subsec. (e) generally. Prior to amendment, subsec. (e) read as follows: “Notwithstanding subsection (a) of this section, in the case of an individual who enrolls during a special enrollment period pursuant to—
“(1) subparagraph (A) of section 1395p(i)(3) of this title—
“(A) before the month in which he attains the age of 70, the coverage period shall begin on the first day of the month in which he has attained the age of 70, or
“(B) in or after the month in which he attains the age of 70, the coverage period shall begin on the first day of the month following the month in which he so enrolls; or
“(2) subparagraph (B) of section 1395p(i)(3) of this title—
“(A) in the first month of the special enrollment period, the coverage period shall begin on the first day of such month, or
“(B) in a month after the first month of the special enrollment period, the coverage period shall begin on the first day of the month following the month in which he so enrolls.”
1984—Subsec. (e). Pub. L. 98–369, § 2338(c), added subsec. (e).
1981—Subsec. (a)(2)(E). Pub. L. 97–35, § 2151(a)(3), substituted “the July 1 following” for “the first day of the third month following”.
Subsec. (b). Pub. L. 97–35, § 2106(b)(2), struck out provision that notice filed by an individual enrolled pursuant to section 1395p(f) of this title shall not be considered a disenrollment for purposes of section 1395p(b) of this title.
1980—Subsec. (a)(2)(E). Pub. L. 96–499, § 945(c)(1), substituted “the first day of the third month” for “the July 1”.
Subsec. (b). Pub. L. 96–499, § 947(b), inserted “(except as otherwise provided in section 1395v(e) of this title)”.
1972—Subsec. (a)(1). Pub. L. 92–603, § 201(c)(3)(A), inserted “or (in the case of a disabled individual who has not attained age 65)
Subsec. (a)(2). Pub. L. 92–603, § 201(c)(3)(B), substituted in subpar. (A) “paragraph (1) or (2)” for “paragraphs (1) and (2)” and in subpars. (B) to (D) “paragraph” for “paragraphs”.
Subsec. (a)(3). Pub. L. 92–603, § 206(b), added par. (3).
Subsec. (b). Pub. L. 92–603, §§ 206(c), 257(a), inserted provisions relating to an individual who is deemed to have enrolled for medical insurance pursuant to section 1395p(f) of this title and an individual who is deemed enrolled for medical insurance benefits pursuant to section 1395p(f) of this title and struck out provisions limiting the allowable grace period to 90 days and inserted provision for extension of such period of up to 180 days where failure to pay premiums is due to good cause.
Subsecs. (c), (d). Pub. L. 92–603, § 202(c)(3)(C), added subsec. (c) and redesignated former subsec. (c) as (d).
1968—Subsec. (b). Pub. L. 90–248 struck out “, during a general enrollment period described in section 1395p(e) of this title,” after “notice” in par. (1), and substituted in first sentence following par. (2) “the calendar quarter following the calendar quarter” for “December 31 of the year”.
Effective Date Of Amendment
Amendment by Pub. L. 109–171 effective
Amendment by Pub. L. 105–33 applicable to involuntary terminations of coverage under a group health plan occurring on or after
Amendment by Pub. L. 103–432 effective on first day of first month beginning after expiration of the 120-day period that begins on
Pub. L. 99–509, title IX, § 9344(b)(2),
Amendment by Pub. L. 99–272 effective
For effective date of amendment by Pub. L. 98–369, see section 2338(d)(2) of Pub. L. 98–369, set out as a note under section 1395p of this title.
Amendment by section 2106(b)(2) of Pub. L. 97–35 effective
Amendment by section 2151(a)(3) of Pub. L. 97–35 not applicable to enrollments pursuant to written requests for enrollment filed before
Amendment by section 945(c)(1) of Pub. L. 96–499 applicable to enrollments occurring on or after
Amendment by section 947(b) of Pub. L. 96–499 applicable to notices filed after third calendar month beginning after
Pub. L. 92–603, title II, § 257(b),
Amendment by Pub. L. 90–248 effective
Miscellaneous
Pub. L. 90–97, § 3(a),
Extension of the general enrollment period under section 1395p(e) of this title through
Pub. L. 89–384, § 3(d),
Commencement of coverage period upon enrollment before