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42 U.S.C. § 1395w–4 — Coverage period
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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Stable record: federal_law:legal_authorities:record_usc_af2f54e39a216a5e5c409504
Source file: Laws/federal/codes/united-states-code/title-42/section-1395w4-coverage-period--044a38f2b8.md
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Source location: Title 42, Chapter 7, § 1395w–4; chapter-007-social-security.md
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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](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](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395p&num=0&edition=prelim) in a month beginning—
(i) before January 1, 2023, the July 1 following the month in which he so enrolls; or
(ii) on or after January 1, 2023, the first day of the month following the month in which he so enrolls; or
(3) in the case of an individual who is deemed to have enrolled—
(A) 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(a) of this title or July 1, 1973, whichever is later, or
(B) on or after the first day of the fourth month of his initial enrollment period, and where such month begins—
(i) before January 1, 2023, as prescribed under subparagraphs (B)(i), (B)(ii), (B)(iii), and (D)(i) of paragraph (2), or
(ii) on or after January 1, 2023, as prescribed under subparagraphs (C) and (D)(ii) of paragraph (2).
**(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](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395v/e&num=0&edition=prelim)) 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](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395p/f&num=0&edition=prelim) or [section 1395p(n)(3) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395p/n/3&num=0&edition=prelim) 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](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395p/f&num=0&edition=prelim) or [section 1395p(n)(3) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395p/n/3&num=0&edition=prelim) 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(a) of this title whose entitlement to hospital insurance benefits under part A 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), 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](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395p/i/3&num=0&edition=prelim) or specified in [section 1395p(i)(4)(A)(i) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395p/i/4/A/i&num=0&edition=prelim)) 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](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395p/k&num=0&edition=prelim), the coverage period shall begin on the first day of the month following the month in which the individual so enrolls.
**(g) Special enrollment periods for exceptional circumstances** Notwithstanding subsection (a), in the case of an individual who enrolls during a special enrollment period pursuant to [section 1395p(m) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395p/m&num=0&edition=prelim), the coverage period shall begin on a date the Secretary provides in a manner consistent (to the extent practicable) with protecting continuity of health benefit coverage.
**(h) Coverage period for individuals only eligible for coverage of immunosuppressive drugs** In the case of an individual described in section 1395o(b)(1) of this title, the following rules shall apply:
(1) In the case of such an individual who is deemed to have enrolled in part B for coverage of immunosuppressive drugs under [section 1395p(n)(3) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395p/n/3&num=0&edition=prelim), such individual’s coverage period shall begin on the first day of the month in which the individual first satisfies section 1395o(b) of this title.
(2) In the case of such an individual who enrolls (or reenrolls, if applicable) in part B for coverage of immunosuppressive drugs under paragraph (2) or (4) of [section 1395p(n) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395p/n&num=0&edition=prelim), such individual’s coverage period shall begin on January 1, 2023, or the month following the month in which the individual so enrolls (or reenrolls), whichever is later.
(3) The provisions of subsections (b) and (d) shall apply with respect to an individual described in paragraph (1) or (2).
(4) In addition to the reasons for termination under subsection (b), the coverage period of an individual described in paragraph (1) or (2) shall end when the individual becomes entitled to benefits under this subchapter under subsection (a) or (b) of [section 426 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section426&num=0&edition=prelim), or under [section 426–1 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section426-1&num=0&edition=prelim), or is no longer eligible for such coverage as a result of the application of section 1395o(b)(2) of this title.
(5) The Secretary may conduct public education activities to raise awareness of the availability of more comprehensive, individual health insurance coverage (as defined in [section 300gg–91 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section300gg-91&num=0&edition=prelim)) for individuals eligible under section 1395o(b) of this title to enroll or to be deemed enrolled in the medical insurance program established under this part for purposes of coverage of immunosuppressive drugs.
**(i) Coverage period for certain Postal Service annuitants and family members** Notwithstanding subsection (a), in the case of an individual who enrolls during the special enrollment period pursuant to section 1395p(o) of this title, the coverage period shall begin on January 1, 2025.
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Scope of benefits** The benefits provided to an individual by the insurance program established by this part shall consist of—
(1) entitlement to have payment made to him or on his behalf (subject to the provisions of this part) for medical and other health services, except those described in subparagraphs (B) and (D) of paragraph (2) and subparagraphs (E) and (F) of [section 1395u(b)(6) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395u/b/6&num=0&edition=prelim); and
(2) entitlement to have payment made on his behalf (subject to the provisions of this part) for—
(A) home health services (other than items described in subparagraph (G) or subparagraph (I));
(B) medical and other health services (other than items described in subparagraph (G) or subparagraph (I)) furnished by a provider of services or by others under arrangement with them made by a provider of services, excluding—
(i) physician services except where furnished by—
(I) a resident or intern of a hospital, or
(II) a physician to a patient in a hospital which has a teaching program approved as specified in paragraph (6) of [section 1395x(b) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395x/b&num=0&edition=prelim) (including services in conjunction with the teaching programs of such hospital whether or not such patient is an inpatient of such hospital) where the conditions specified in paragraph (7) of such section are met,
(ii) services for which payment may be made pursuant to [section 1395n(b)(2) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395n/b/2&num=0&edition=prelim),
(iii) services described by [section 1395x(s)(2)(K)(i) of
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395v
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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) 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
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395p
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Requirement of requests and certifications** Except as provided in subsections (d) and (g) and in [section 1395mm of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395mm&num=0&edition=prelim), payment for services furnished an individual may be made only to providers of services which are eligible therefor under [section 1395cc of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395cc&num=0&edition=prelim) and only if—
(1) written request, signed by such individual, except in cases in which the Secretary finds it impracticable for the individual to do so, is filed for such payment in such form, in such manner, and by such person or persons as the Secretary may by regulation prescribe, no later than the close of the period ending 1 calendar year after the date of service;
(2) a physician, or, in the case of services described in subparagraph (B), a physician, or a nurse practitioner, a clinical nurse specialist, or a physician assistant (as those terms are defined in [section 1395x(aa)(5) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395x/aa/5&num=0&edition=prelim)) who does not have a direct or indirect employment relationship with the facility but is working in collaboration with a physician,,11 So in original. or, in the case of services described in subparagraph (C), a physician, a nurse practitioner or clinical nurse specialist (as such terms are defined in [section 1395x(aa)(5) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395x/aa/5&num=0&edition=prelim)) who is working in accordance with State law, or a physician assistant (as defined in [section 1395x(aa)(5) of this title](https://usc
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395j
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Conditions of participation; protection of individual rights; notification of State entities; use of home health aides; medical equipment; individual’s plan of care; compliance with Federal, State, and local laws and regulations** The conditions of participation that a home health agency is required to meet under this subsection are as follows:
(1) The agency protects and promotes the rights of each individual under its care, including each of the following rights:
(A) The right to be fully informed in advance about the care and treatment to be provided by the agency, to be fully informed in advance of any changes in the care or treatment to be provided by the agency that may affect the individual’s well-being, and (except with respect to an individual adjudged incompetent) to participate in planning care and treatment or changes in care or treatment.
(B) The right to voice grievances with respect to treatment or care that is (or fails to be) furnished without discrimination or reprisal for voicing grievances.
(C) The right to confidentiality of the clinical records described in section 1395x(o)(3) of this title.
(D) The right to have one’s property treated with respect.
(E) The right to be fully informed orally and in writing (in advance of coming under the care of the agency) of—
(i) all items and services furnished by (or under arrangements with) the agency for which payment may be made under this subchapter,
(ii) the coverage available for such items and services under this subchapter, subchapter XIX, and any other Federal program of which the agency is reasonably aware,
(iii) any charges for items and services not covered under this subchapter and any charges the individual may have to pay with respect to items and services furn
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Purpose** The purpose of this section is to provide for adjustments of estimates of budgetary effects of PAYGO legislation for legislation affecting 4 areas of the budget—
(1) payments made under [section 1395w–4 of title 42](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w–4&num=0&edition=prelim) (referred to in this section as “Payment for Physicians’ Services”);
(2) the Estate and Gift Tax under subtitle B of title 26;
(3) the AMT; and
(4) provisions of EGTRRA or JGTRRA that amended title 26 (or provisions in later statutes further amending the amendments made by EGTRRA or JGTRRA), other than—
(A) the provisions of those 2 Acts that were made permanent by the Pension Protection Act of 2006 (Public Law 109–280);
(B) amendments to the Estate and Gift Tax referred to in paragraph (2);
(C) the AMT referred to in paragraph (3); and
(D) the income tax rates on ordinary income that apply to individuals with adjusted gross incomes greater than $200,000 for a single filer and $250,000 for joint filers.
**(b) Duration** This section shall remain in effect through December 31, 2011.
**(c) Medicare payments to physicians**
(1) **Criteria** — Legislation that includes provisions amending or superseding the system for updating payments under subsections (d) and (f) of [section 1395w–4 of title 42](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395w–4&num=0&edition=prelim) shall trigger the current policy adjustment required by this chapter.
(2) **Adjustment** — The amount of the maximum current policy adjustment shall be the difference between—
(A) estimated net outlays attributable to the payment rates and related parameters in accordance with subsections (d) and (f) of [section 1395w–4 of
Source: Supplied U.S. Code snapshot — release unconfirmed · 2 U.S.C. § 936
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Married individuals filing joint returns and surviving spouses** There is hereby imposed on the taxable income of—
(1) every married individual (as defined in section 7703) who makes a single return jointly with his spouse under section 6013, and
(2) every surviving spouse (as defined in section 2(a)),
a tax determined in accordance with the following table: If taxable income is:The tax is: Not over $36,90015% of taxable income. Over $36,900 but not over $89,150$5,535, plus 28% of the excess over $36,900. Over $89,150 but not over $140,000$20,165, plus 31% of the excess over $89,150. Over $140,000 but not over $250,000$35,928.50, plus 36% of the excess over $140,000. Over $250,000$75,528.50, plus 39.6% of the excess over $250,000.
**(b) Heads of households** There is hereby imposed on the taxable income of every head of a household (as defined in section 2(b)) a tax determined in accordance with the following table: If taxable income is:The tax is: Not over $29,60015% of taxable income. Over $29,600 but not over $76,400$4,440, plus 28% of the excess over $29,600. Over $76,400 but not over $127,500$17,544, plus 31% of the excess over $76,400. Over $127,500 but not over $250,000$33,385, plus 36% of the excess over $127,500. Over $250,000$77,485, plus 39.6% of the excess over $250,000.
**(c) Unmarried individuals (other than surviving spouses and heads of households)** There is hereby imposed on the taxable income of every individual (other than a surviving spouse as defined in section 2(a) or the head of a household as defined in section 2(b)) who is not a married individual (as defined in section 7703) a tax determined in accordance with the following table: If taxable income is:The tax is: Not over $22,10015% of taxable income. Over $22,100 but not over $53,50
Source: Supplied U.S. Code snapshot — release unconfirmed · 26 U.S.C. § 1
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Federal law — U.S. Code and appendices · legal_authorities
**(a)** The benefits to be provided under plans described by [section 8903 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title5-section8903&num=0&edition=prelim) may be of the following types:
(1) **Service Benefit Plan.—**
(A) Hospital benefits.
(B) Surgical benefits.
(C) In-hospital medical benefits.
(D) Ambulatory patient benefits.
(E) Supplemental benefits.
(F) Obstetrical benefits.
(2) **Indemnity Benefit Plan.—**
(A) Hospital care.
(B) Surgical care and treatment.
(C) Medical care and treatment.
(D) Obstetrical benefits.
(E) Prescribed drugs, medicines, and prosthetic devices.
(F) Other medical supplies and services.
(3) **Employee Organization Plans.—** — Benefits of the types named under paragraph (1) or (2) of this subsection or both.
(4) **Comprehensive Medical Plans.—** — Benefits of the types named under paragraph (1) or (2) of this subsection or both.
All plans contracted for under paragraphs (1) and (2) of this subsection shall include benefits both for costs associated with care in a general hospital and for other health services of a catastrophic nature.
**(b)**
(1)
(A) A plan, other than a prepayment plan described in [section 8903(4) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title5-section8903/4&num=0&edition=prelim), may not provide benefits, in the case of any retired enrolled individual who is age 65 or older and is not covered to receive Medicare hospital and insurance benefits under 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.), to pay a charge imposed by any health care provider, for inpatient hospital serv
Source: Supplied U.S. Code snapshot — release unconfirmed · 5 U.S.C. § 8904
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