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42 U.S.C. § 1395p — Hospital insurance benefits for disabled individuals who have exhausted other entitlement
Federal law — U.S. Code and appendices · legal_authorities
**(a) Eligibility** Every individual who—
(1) has not attained the age of 65;
(2)
(A) has been entitled to benefits under this part under [section 426(b) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section426/b&num=0&edition=prelim), and
(B)
(i) continues to have the disabling physical or mental impairment on the basis of which the individual was found to be under a disability or to be a disabled qualified railroad retirement beneficiary, or (ii) is blind (within the meaning of [section 416(i)(1) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section416/i/1&num=0&edition=prelim)), but
(C) whose entitlement under [section 426(b) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section426/b&num=0&edition=prelim) ends due solely to the individual having earnings that exceed the substantial gainful activity amount (as defined in [section 423(d)(4) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section423/d/4&num=0&edition=prelim)); and
(3) is not otherwise entitled to benefits under this part,
shall be eligible to enroll in the insurance program established by this part.
**(b) Enrollment**
(1) 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.
(2) The individual’s initial enrollment period shall begin with the month in which the individual receives notice that the individual’s entitlement to benefits under [section 426(b) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section426/b&num=0&edition=prelim) will end due solely to the individual h
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Stable record: federal_law:legal_authorities:record_usc_8e16101e0ae1951e9f829a59
Source file: Laws/federal/codes/united-states-code/title-42/section-1395p-hospital-insurance-benefits-for-disabled-individuals-who-have-exhausted--e53ee5dbb3.md
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Passage SHA-256: 73a276bee1086eccec064dd1ec9a5c54698ebf47b71e61d6eda569da4cffe39c
Source location: Title 42, Chapter 7, § 1395p; chapter-007-social-security.md
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**(a) Eligibility** Every individual who—
(1) has not attained the age of 65;
(2)
(A) has been entitled to benefits under this part under [section 426(b) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section426/b&num=0&edition=prelim), and
(B)
(i) continues to have the disabling physical or mental impairment on the basis of which the individual was found to be under a disability or to be a disabled qualified railroad retirement beneficiary, or (ii) is blind (within the meaning of [section 416(i)(1) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section416/i/1&num=0&edition=prelim)), but
(C) whose entitlement under [section 426(b) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section426/b&num=0&edition=prelim) ends due solely to the individual having earnings that exceed the substantial gainful activity amount (as defined in [section 423(d)(4) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section423/d/4&num=0&edition=prelim)); and
(3) is not otherwise entitled to benefits under this part,
shall be eligible to enroll in the insurance program established by this part.
**(b) Enrollment**
(1) 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.
(2) The individual’s initial enrollment period shall begin with the month in which the individual receives notice that the individual’s entitlement to benefits under [section 426(b) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section426/b&num=0&edition=prelim) will end due solely to the individual having earnings that exceed the substantial gainful activity amount (as defined in [section 423(d)(4) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section423/d/4&num=0&edition=prelim) and shall end 7 months later.
(3) There shall be a general enrollment period during the period beginning on January 1 and ending on March 31 of each year (beginning with 1990).
**(c) Coverage period**
(1) The period (in this subsection referred to as a “coverage period”) during which an individual is entitled to benefits under the insurance program under this part shall begin on whichever of the following is the latest:
(A) In the case of an individual who enrolls under subsection (b)(2) before the month in which the individual first satisfies subsection (a), the first day of such month.
(B) In the case of an individual who enrolls under subsection (b)(2) in the month in which the individual first satisfies subsection (a), the first day of the month following the month in which the individual so enrolls.
(C) In the case of an individual who enrolls under subsection (b)(2) in the month following the month in which the individual first satisfies subsection (a), the first day of the second month following the month in which the individual so enrolls.
(D) In the case of an individual who enrolls under subsection (b)(2) more than one month following the month in which the individual first satisfies subsection (a), the first day of the third month following the month in which the individual so enrolls.
(E) In the case of an individual who enrolls under subsection (b)(3), the July 1 following the month in which the individual so enrolls.
(2) An individual’s coverage period under this section shall continue until the individual’s enrollment is terminated as follows:
(A) As of the month following the month in which the Secretary provides notice to the individual that the individual no longer meets the condition described in subsection (a)(2)(B).
(B) As of the month following the month in which the individual files notice that the individual no longer wishes to participate in the insurance program established by this part.
(C) As of the month before the first month in which the individual becomes eligible for hospital insurance benefits under section 426(a) or 426–1 of this title.
(D) As of a date, determined under regulations of the Secretary, for nonpayment of premiums.
The regulations under subparagraph (D) may provide a grace period of not longer than 90 days, which 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. Termination of coverage under this section shall result in simultaneous termination of any coverage affected under any other part of this subchapter.
(3) The provisions of subsections (h), (i), and (m) of [section 1395p of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395p&num=0&edition=prelim) apply to enrollment and nonenrollment under this section in the same manner as they apply to enrollment and nonenrollment and special enrollment periods under [section 1395i–2 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395i-2&num=0&edition=prelim).
**(d) Payment of premiums**
(1)
(A) Premiums for enrollment under this section shall be paid to the Secretary at such times, and in such manner, as the Secretary shall by regulations prescribe, and shall be deposited in the Treasury to the credit of the Federal Hospital Insurance Trust Fund.
(B)
(i) Subject to clause (ii), such premiums shall be payable for the period commencing with the first month of an individual’s coverage period and ending with the month in which the individual dies or, if earlier, in which the individual’s coverage period terminates.
(ii) Such premiums shall not be payable for any month in which the individual is eligible for benefits under this part pursuant to [section 426(b) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section426/b&num=0&edition=prelim).
(2) The provisions of subsections (d) through (f) of [section 1395i–2 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395i-2&num=0&edition=prelim) (relating to premiums) shall apply to individuals enrolled under this section in the same manner as they apply to individuals enrolled under that section.
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Federal law — U.S. Code and appendices · legal_authorities
Nothing in this subchapter shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine or the manner in which medical services are provided, or over the selection, tenure, or compensation of any officer or employee of any institution, agency, or person providing health services; or to exercise any supervision or control over the administration or operation of any such institution, agency, or person.
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395c
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Employer practices** It shall be unlawful for an employer—
(1) to fail or refuse to hire or to discharge any individual or otherwise discriminate against any individual with respect to his compensation, terms, conditions, or privileges of employment, because of such individual’s age;
(2) to limit, segregate, or classify his employees in any way which would deprive or tend to deprive any individual of employment opportunities or otherwise adversely affect his status as an employee, because of such individual’s age; or
(3) to reduce the wage rate of any employee in order to comply with this chapter.
**(b) Employment agency practices** It shall be unlawful for an employment agency to fail or refuse to refer for employment, or otherwise to discriminate against, any individual because of such individual’s age, or to classify or refer for employment any individual on the basis of such individual’s age.
**(c) Labor organization practices** It shall be unlawful for a labor organization—
(1) to exclude or to expel from its membership, or otherwise to discriminate against, any individual because of his age;
(2) to limit, segregate, or classify its membership, or to classify or fail or refuse to refer for employment any individual, in any way which would deprive or tend to deprive any individual of employment opportunities, or would limit such employment opportunities or otherwise adversely affect his status as an employee or as an applicant for employment, because of such individual’s age;
(3) to cause or attempt to cause an employer to discriminate against an individual in violation of this section.
**(d) Opposition to unlawful practices; participation in investigations, proceedings, or litigation** It shall be unlawful for an employer to discriminate against any
Source: Supplied U.S. Code snapshot — release unconfirmed · 29 U.S.C. § 623
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Individuals at least 40 years of age** The prohibitions in this chapter shall be limited to individuals who are at least 40 years of age.
**(b) Employees or applicants for employment in Federal Government** In the case of any personnel action affecting employees or applicants for employment which is subject to the provisions of [section 633a of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section633a&num=0&edition=prelim), the prohibitions established in [section 633a of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section633a&num=0&edition=prelim) shall be limited to individuals who are at least 40 years of age.
**(c) Bona fide executives or high policymakers**
(1) Nothing in this chapter shall be construed to prohibit compulsory retirement of any employee who has attained 65 years of age and who, for the 2-year period immediately before retirement, is employed in a bona fide executive or a high policymaking position, if such employee is entitled to an immediate nonforfeitable annual retirement benefit from a pension, profit-sharing, savings, or deferred compensation plan, or any combination of such plans, of the employer of such employee, which equals, in the aggregate, at least $44,000.
(2) In applying the retirement benefit test of paragraph (1) of this subsection, if any such retirement benefit is in a form other than a straight life annuity (with no ancillary benefits), or if employees contribute to any such plan or make rollover contributions, such benefit shall be adjusted in accordance with regulations prescribed by the Equal Employment Opportunity Commission, after consultation with the Secretary of the Treasury, so that the benefit is the equivalent of a straight life annuity (w
Source: Supplied U.S. Code snapshot — release unconfirmed · 29 U.S.C. § 631
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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
**(a) Payments to providers of services or other person regarded as payment to individuals** Any payment under this subchapter to any provider of services or other person with respect to any items or services furnished any individual shall be regarded as a payment to such individual.
**(b) Incorrect payments on behalf of individuals; payment adjustment** Where—
(1) more than the correct amount is paid under this subchapter to a provider of services or other person for items or services furnished an individual and the Secretary determines (A) that, within such period as he may specify, the excess over the correct amount cannot be recouped from such provider of services or other person, or (B) that such provider of services or other person was without fault with respect to the payment of such excess over the correct amount, or
(2) any payment has been made under [section 1395f(e) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395f/e&num=0&edition=prelim) to a provider of services or other person for items or services furnished an individual,
proper adjustments shall be made, under regulations prescribed (after consultation with the Railroad Retirement Board) by the Secretary, by decreasing subsequent payments—
(3) to which such individual is entitled under subchapter II of this chapter or under the Railroad Retirement Act of 1974 [[45 U.S.C. 231](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title45-section231&num=0&edition=prelim) et seq.], as the case may be, or
(4) if such individual dies before such adjustment has been completed, to which any other individual is entitled under subchapter II of this chapter or under the Railroad Retirement Act of 1974 [[45 U.S.C. 231](https://uscode.house.gov/view.xhtml?r
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395rr
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Duty of Secretary; enrollment of eligible individuals** The Secretary shall, at the request of a State made before January 1, 1970, or during 1981 or after 1988, enter into an agreement with such State pursuant to which all eligible individuals in either of the coverage groups described in subsection (b) (as specified in the agreement) will be enrolled under the program established by this part.
**(b) Coverage of groups to which applicable** An agreement entered into with any State pursuant to subsection (a) may be applicable to either of the following coverage groups:
(1) individuals receiving money payments under the plan of such State approved under subchapter I or subchapter XVI; or
(2) individuals receiving money payments under all of the plans of such State approved under subchapters I, X, XIV, and XVI, and part A of subchapter IV.
Except as provided in subsection (g), there shall be excluded from any coverage group any individual who is entitled to monthly insurance benefits under subchapter II or who is entitled to receive an annuity under the Railroad Retirement Act of 1974 [[45 U.S.C. 231](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title45-section231&num=0&edition=prelim) et seq.]. Effective January 1, 1974, and subject to [section 1396a(f) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1396a/f&num=0&edition=prelim), the Secretary shall, at the request of any State not eligible to participate in the State plan program established under subchapter XVI, continue in effect the agreement entered into under this section with such State subject to such modifications as the Secretary may by regulations provide to take account of the termination of any plans of such State approved under subchapters
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395w–24
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Federal law — U.S. Code and appendices · legal_authorities
**(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](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395p&num=0&edition=prelim) before the month in which he first satisfies paragraph (1) or (2) of section 1395o(a) of this title, the first day of such month,
(B) in the case of an individual who first satisfies such paragraph in a month beginning before January 2023 and who enrolls pursuant to such subsection (d)—
(i) in such month in which he first satisfies such paragraph, the first day of the month following the month in which he so enrolls,
(ii) in the month following such month in which he first satisfies such paragraph, the first day of the second month following the month in which he so enrolls, or
(iii) more than one month following such month in which he satisfies such paragraph, the first day of the third month following the month in which he so enrolls,
(C) in the case of an individual who first satisfies such paragraph in a month beginning on or after January 1, 2023, and who enrolls pursuant to such subsection (d) in such month in which he first satisfies such paragraph or in any subsequent month of his initial enrollment period, the first day of the month following the month in which he so enrolls, or
(D) in the case of an individual who enrolls pursuant to subsection (e) of [section 1395p of this title]
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395w–4
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Determination of monthly actuarial rates and premiums**
(1) The Secretary shall, during September of 1983 and of each year thereafter, determine the monthly actuarial rate for enrollees age 65 and over which shall be applicable for the succeeding calendar year. Subject to paragraphs (5), (6), and (7), such actuarial rate shall be the amount the Secretary estimates to be necessary so that the aggregate amount for such calendar year with respect to those enrollees age 65 and older will equal one-half of the total of the benefits and administrative costs which he estimates will be payable from the Federal Supplementary Medical Insurance Trust Fund for services performed and related administrative costs incurred in such calendar year with respect to such enrollees. In calculating the monthly actuarial rate, the Secretary shall include an appropriate amount for a contingency margin. In applying this paragraph there shall not be taken into account additional payments under section 1395w–4(o) of this title and section 1395w–23(l)(3) of this title and the Government contribution under [section 1395w(a)(3) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w/a/3&num=0&edition=prelim).
(2) The monthly premium of each individual enrolled under this part for each month after December 1983 shall be the amount determined under paragraph (3), adjusted as required in accordance with subsections (b), (c), (f), and (i), and to reflect any credit provided under [section 1395w–24(b)(1)(C)(ii)(III) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w–24/b/1/C/ii/III&num=0&edition=prelim).
(3) The Secretary, during September of each year, shall determine and promulgate a monthly premium rate for
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395w–5
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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) Definitions.—** In this section—
(1) the term “covered Medicare individual” means an individual who is entitled to benefits under Medicare part A, but excluding an individual who is eligible to enroll under such part under section 1818 or 1818A of the Social Security Act ([42 U.S.C. 1395i–2](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395i–2&num=0&edition=prelim), 1395i–2a);
(2) the term “initial contract year” means the contract year beginning in January of 2025;
(3) the term “initial participating carrier” means a carrier that enters into a contract with the Office to participate in the Program during the initial contract year;
(4) the term “Medicare part A” means part A of title XVIII of the Social Security Act ([42 U.S.C. 1395c](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395c&num=0&edition=prelim) et seq.);
(5) the term “Medicare part B” means part B of title XVIII of the Social Security Act ([42 U.S.C. 1395j](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395j&num=0&edition=prelim) et seq.);
(6) the term “Office” means the Office of Personnel Management;
(7) the term “Postal Service” means the United States Postal Service;
(8) the term “Postal Service annuitant” means an annuitant enrolled in a health benefits plan under this chapter whose Government contribution is required to be paid under section 8906(g)(2);
(9) the term “Postal Service employee” means an employee of the Postal Service enrolled in a health benefits plan under this chapter whose Government contribution is paid by the Postal Service;
(10) the term “Postal Service Medicare covered annuitant” means an individual who—
(A) is a Postal Service annuitant; and
(B) is a covered Medicare i
Source: Supplied U.S. Code snapshot — release unconfirmed · 5 U.S.C. § 8903c
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