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42 U.S.C. § 426a — Transitional provision on eligibility of uninsured individuals for hospital insurance benefits
Federal law — U.S. Code and appendices · legal_authorities
**(a) Entitlement to benefits** Anyone who—
(1) has attained the age of 65,
(2)
(A) attained such age before 1968, or (B) has not less than 3 quarters of coverage (as defined in this subchapter or section 228e(l) of title 45), whenever acquired, for each calendar year elapsing after 1966 and before the year in which he attained such age,
(3) is not, and upon filing application for monthly insurance benefits under [section 402 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section402&num=0&edition=prelim) would not be, entitled to hospital insurance benefits under [section 426 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section426&num=0&edition=prelim), and is not certifiable as a qualified railroad retirement beneficiary under [section 228s–2 of title 45](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title45-section228s–2&num=0&edition=prelim),
(4) is a resident of the United States (as defined in [section 410(i) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section410/i&num=0&edition=prelim)), and is (A) a citizen of the United States or (B) an alien lawfully admitted for permanent residence who has resided in the United States (as so defined) continuously during the 5 years immediately preceding the month in which he files application under this section, and
(5) has filed an application under this section in such manner and in accordance with such other requirements as may be prescribed in regulations of the Secretary,
shall (subject to the limitations in this section) be deemed, solely for purposes of [section 426 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section426&num=0&edition=prelim), t
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Stable record: federal_law:legal_authorities:record_usc_38cec42242d0eb1f846eaf98
Source file: Laws/federal/codes/united-states-code/title-42/section-426a-transitional-provision-on-eligibility-of-uninsured-individuals-for-hospi--273be1254a.md
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Source location: Title 42, Chapter 7, § 426a; chapter-007-social-security.md
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**(a) Entitlement to benefits** Anyone who—
(1) has attained the age of 65,
(2)
(A) attained such age before 1968, or (B) has not less than 3 quarters of coverage (as defined in this subchapter or section 228e(l) of title 45), whenever acquired, for each calendar year elapsing after 1966 and before the year in which he attained such age,
(3) is not, and upon filing application for monthly insurance benefits under [section 402 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section402&num=0&edition=prelim) would not be, entitled to hospital insurance benefits under [section 426 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section426&num=0&edition=prelim), and is not certifiable as a qualified railroad retirement beneficiary under [section 228s–2 of title 45](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title45-section228s–2&num=0&edition=prelim),
(4) is a resident of the United States (as defined in [section 410(i) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section410/i&num=0&edition=prelim)), and is (A) a citizen of the United States or (B) an alien lawfully admitted for permanent residence who has resided in the United States (as so defined) continuously during the 5 years immediately preceding the month in which he files application under this section, and
(5) has filed an application under this section in such manner and in accordance with such other requirements as may be prescribed in regulations of the Secretary,
shall (subject to the limitations in this section) be deemed, solely for purposes of [section 426 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section426&num=0&edition=prelim), to be entitled to monthly insurance benefits under such section 402 for each month, beginning with the first month in which he meets the requirements of this subsection and ending with the month in which he dies, or, if earlier, the month before the month in which he becomes (or upon filing application for monthly insurance benefits under [section 402 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section402&num=0&edition=prelim) would become) entitled to hospital insurance benefits under [section 426 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section426&num=0&edition=prelim) or becomes certifiable as a qualified railroad retirement beneficiary. An individual who would have met the preceding requirements of this subsection in any month had he filed application under paragraph (5) hereof before the end of such month shall be deemed to have met such requirements in such month if he files such application before the end of the twelfth month following such month. No application under this section which is filed by an individual more than 3 months before the first month in which he meets the requirements of paragraphs (1), (2), (3), and (4) shall be accepted as an application for purposes of this section.
**(b) Persons ineligible** The provisions of subsection (a) shall not apply to any individual who—
(1) is, at the beginning of the first month in which he meets the requirements of subsection (a), a member of any organization referred to in section 410(a)(17) 11 See References in Text note below. of this title,
(2) has, prior to the beginning of such first month, been convicted of any offense listed in [section 402(u) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section402/u&num=0&edition=prelim), or
(3)
(A) at the beginning of such first month is covered by an enrollment in a health benefits plan under chapter 89 of title 5,
(B) was so covered on February 16, 1965, or
(C) could have been so covered for such first month if he or some other person had availed himself of opportunities to enroll in a health benefits plan under such chapter and to continue such enrollment (but this subparagraph shall not apply unless he or such other person was a Federal employee at any time after February 15, 1965).
Paragraph (3) shall not apply in the case of any individual for the month (or any month thereafter) in which coverage under such a health benefits plan ceases (or would have ceased if he had had such coverage) by reason of his or some other person’s separation from Federal service, if he or such other person was not (or would not have been) eligible to continue such coverage after such separation.
**(c) Authorization of appropriations** There are authorized to be appropriated to the Federal Hospital Insurance Trust Fund (established by [section 1395i of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395i&num=0&edition=prelim)) from time to time such sums as the Secretary deems necessary for any fiscal year, on account of—
(1) payments made or to be made during such fiscal year from such Trust Fund under part A of subchapter XVIII of this chapter with respect to individuals who are entitled to hospital insurance benefits under [section 426 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section426&num=0&edition=prelim) solely by reason of this section,
(2) the additional administrative expenses resulting or expected to result therefrom, and
(3) any loss in interest to such Trust Fund resulting from the payment of such amounts,
in order to place such Trust Fund in the same position at the end of such fiscal year in which it would have been if the preceding subsections of this section had not been enacted.
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Individuals over 65 years** Every individual who—
(1) has attained age 65, and
(2)
(A) is entitled to monthly insurance benefits under [section 402 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section402&num=0&edition=prelim), would be entitled to those benefits except that he has not filed an application therefor (or application has not been made for a benefit the entitlement to which for any individual is a condition of entitlement therefor), or would be entitled to such benefits but for the failure of another individual, who meets all the criteria of entitlement to monthly insurance benefits, to meet such criteria throughout a month, and, in conformity with regulations of the Secretary, files an application for hospital insurance benefits under part A of subchapter XVIII,
(B) is a qualified railroad retirement beneficiary, or
(C)
(i) would meet the requirements of subparagraph (A) upon filing application for the monthly insurance benefits involved if medicare qualified government employment (as defined in [section 410(p) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section410/p&num=0&edition=prelim)) were treated as employment (as defined in [section 410(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section410/a&num=0&edition=prelim)) for purposes of this subchapter, and (ii) files an application, in conformity with regulations of the Secretary, for hospital insurance benefits under part A of subchapter XVIII,
shall be entitled to hospital insurance benefits under part A of subchapter XVIII for each month for which he meets the condition specified in paragraph (2), beginning with the first month after June 1966 for which he meet
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 426
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Old-age insurance benefits** Every individual who—
(1) is a fully insured individual (as defined in [section 414(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section414/a&num=0&edition=prelim)),
(2) has attained age 62, and
(3) has filed application for old-age insurance benefits or was entitled to disability insurance benefits for the month preceding the month in which he attained retirement age (as defined in section 416(l) of this title),
shall be entitled to an old-age insurance benefit for each month, beginning with—
(A) in the case of an individual who has attained retirement age (as defined in section 416(l) of this title), the first month in which such individual meets the criteria specified in paragraphs (1), (2), and (3), or
(B) in the case of an individual who has attained age 62, but has not attained retirement age (as defined in section 416(l) of this title), the first month throughout which such individual meets the criteria specified in paragraphs (1) and (2) (if in that month he meets the criterion specified in paragraph (3)),
and ending with the month preceding the month in which he dies. Except as provided in subsection (q) and subsection (w), such individual’s old-age insurance benefit for any month shall be equal to his primary insurance amount (as defined in [section 415(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section415/a&num=0&edition=prelim)) for such month.
**(b) Wife’s insurance benefits**
(1) The wife (as defined in [section 416(b) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section416/b&num=0&edition=prelim)) and every divorced wife (as defined in [section 416(d) of this title](https://uscode.house.gov/
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 402
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Grants** The Secretary of Health and Human Services (in this section referred to as the “Secretary”) shall make grants to States, with approved State regulatory programs under [section 1395ss of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395ss&num=0&edition=prelim), that submit applications to the Secretary that meet the requirements of this section for the purpose of providing information, counseling, and assistance relating to the procurement of adequate and appropriate health insurance coverage to individuals who are eligible to receive benefits under this subchapter (in this section referred to as “eligible individuals”). The Secretary shall prescribe regulations to establish a minimum level of funding for a grant issued under this section.
**(b) Grant applications**
(1) In submitting an application under this section, a State may consolidate and coordinate an application that consists of parts prepared by more than one agency or department of such State.
(2) As part of an application for a grant under this section, a State shall submit a plan for a State-wide health insurance information, counseling, and assistance program. Such program shall—
(A) establish or improve upon a health insurance information, counseling, and assistance program that provides counseling and assistance to eligible individuals in need of health insurance information, including—
(i) information that may assist individuals in obtaining benefits and filing claims under this subchapter and subchapter XIX of this chapter;
(ii) policy comparison information for medicare supplemental policies (as described in [section 1395ss(g)(1) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395ss/g/1
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395i
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Individuals eligible to enroll** Every individual who—
(1) has attained the age of 65,
(2) is enrolled under part B of this subchapter,
(3) is a resident of the United States, and is either (A) a citizen or (B) an alien lawfully admitted for permanent residence who has resided in the United States continuously during the 5 years immediately preceding the month in which he applies for enrollment under this section, and
(4) is not otherwise entitled to benefits under this part,
shall be eligible to enroll in the insurance program established by this part. 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](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395i-2a&num=0&edition=prelim).
**(b) Time, manner, and form of enrollment** An individual may enroll under this section only in such manner and form as may be prescribed in regulations, and only during an enrollment period prescribed in or under this section.
**(c) Period of enrollment; scope of coverage** The provisions of [section 1395p of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395p&num=0&edition=prelim) (except subsections (f) and (o) thereof), [section 1395q of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395q&num=0&edition=prelim), subsection (b) of [section 1395r of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395r&num=0&edition=prelim), and subsections (f) and (h) of [section 1395s of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395o
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Federal law — U.S. Code and appendices · legal_authorities
Page 2101
TITLE 42—THE PUBLIC HEALTH AND WELFARE
§ 426a
purposes of coverage of immunosuppressive drugs de-
scribed in section 1395x(s)(2)(J) of this title)’’ before
‘‘, with the thirty-sixth month’’.
2015—Subsec. (c). Pub. L. 114–74 struck out subsec. (c)
relating to continuing eligibility of certain terminated
individuals.
1994—Subsec. (c). Pub. L. 103–296 added subsec. (c) re-
lating to continuing eligibility of certain terminated
individuals.
1986—Subsec. (a)(1)(A)(ii), (B)(iii). Pub. L. 99–272 sub-
stituted ‘‘medicare qualified government employment’’
for ‘‘medicare qualified Federal employment’’.
1983—Subsec. (a)(1)(B)(iii). Pub. L. 97–448 substituted
‘‘section 410(p)’’ for ‘‘410(p)’’ and struck out ‘‘after De-
cember 31, 1982,’’.
1982—Subsec. (a)(1)(A). Pub. L. 97–248 designated ex-
isting provisions as cl. (i), substituted ‘‘within the
meaning of the term ‘employment’ for purposes of this
subchapter’’ for ‘‘in the term ‘employment’ as defined
in this chapter’’, and added cl. (ii).
Subsec. (a)(1)(B). Pub. L. 97–248 designated ‘‘is enti-
tled to monthly insurance benefits under this sub-
chapter’’ as cl. (i), substituted ‘‘(ii) is entitled to an an-
nuity under the Railroad Retirement Act of 1974’’ for
‘‘or an annuity under the Railroad Retirement Act of
1974’’, and added cl. (iii).
Subsec. (a)(1)(C), (D). Pub. L. 97–248 combined former
subpars. (C) and (D) into subpar. (C) and substituted a
reference to individuals described in subpar. (A) or (B)
for a more detailed definition of such individuals.
Statutory Notes and Related Subsidiaries
EFFECTIVE DATE OF 1994 AMENDMENT
Amendment by Pub. L. 103–296 applicable with re-
spect to benefits based on disability (as defined in sec-
tion 425(c)(9) of this title) which are otherwise payable
in mon
Source: Supplied 2024 U.S. Code historical extraction · 42 U.S.C. § 426a
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