42 U.S.C. § 1395o — Eligible individuals

Page 3171 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1395p terim report on the demonstration project and, not later than four years after Dec. 22, 1987, a final report on results of the project. § 1395o. Eligible individuals (a) In general Every individual who— (1) is entitled to hospital insurance benefits under part A, or (2) has attained age 65 and is a resident of the United States, and is either (A) a citizen or (B) an alien lawfully admitted for perma- nent residence who has resided in the United States continuously during the 5 years imme- diately preceding the month in which he ap- plies for enrollment under this part, is eligible to enroll in the insurance program es- tablished by this part. (b) Individuals eligible for immunosuppressive drug coverage (1) In general Except as provided under paragraph (2), every individual whose entitlement to insur- ance benefits under part A ends (whether be- fore, on, or after January 1, 2023) by reason of section 426–1(b)(2) of this title is eligible to en- roll or to be deemed to have enrolled in the medical insurance program established by this part solely for purposes of coverage of im- munosuppressive drugs in accordance with section 1395p(n) of this title. (2) Exception if other coverage is available (A) In general An individual described in paragraph (1) shall not be eligible for enrollment in the program for purposes of coverage described in such paragraph with respect to any period in which the individual, as determined in ac- cordance with subparagraph (B)— (i) is enrolled in a group health plan or group or individual health insurance cov- erage, as such terms are defined in section 300gg–91 of this title; (ii) is enrolled for coverage under the TRICARE for Life program under section 1086(d) of title 10; (iii) is enrolled under a State plan (or waiver of such plan) under subchapter XIX and is eligible to receive benefits for im- munosuppressive drugs described in this subsection under such plan (or such waiv- er); (iv) is enrolled under a State child health plan (or waiver of such plan) under subchapter XXI and is eligible to receive benefits for such drugs under such plan (or such waiver); or (v)(I) is enrolled in the patient enroll- ment system of the Department of Vet- erans Affairs established and operated under section 1705 of title 38; (II) is not required to enroll under sec- tion 1705 of such title to receive immuno- suppressive drugs described in this sub- section; or (III) is otherwise eligible under a provi- sion of title 38, other than section 1710 of such title to receive immunosuppressive drugs described in this subsection. (B) Eligibility determinations (i) In general The Secretary, in coordination with the Commissioner of Social Security, shall es- tablish a process for determining whether an individual described in paragraph (1) who is to be enrolled or deemed to be en- rolled in the medical insurance program described in such paragraph meets the re- quirements for such enrollment under this subsection, including the requirement that the individual not be enrolled in other cov- erage as described in subparagraph (A). (ii) Attestation regarding other coverage The process established under clause (i) shall include, at a minimum, a require- ment that— (I) the individual provide to the Com- missioner an attestation that the indi- vidual is not enrolled and does not ex- pect to enroll in such other coverage; and (II) the individual notify the Commis- sioner within 60 days of enrollment in such other coverage. (Aug. 14, 1935, ch. 531, title XVIII, § 1836, as added Pub. L. 89–97, title I, § 102(a), July 30, 1965, 79 Stat. 304; amended Pub. L. 92–603, title II, § 201(c)(1), Oct. 30, 1972, 86 Stat. 1372; Pub. L. 116–260, div. CC, title IV, § 402(a)(2)(A), Dec. 27, 2020, 134 Stat. 2998.) Editorial Notes AMENDMENTS 2020—Pub. L. 116–260 designated existing provisions as subsec. (a), inserted heading, and added subsec. (b). 1972—Pub. L. 92–603 designed former par. (2)(B) as par. (1), former par. (1) as introductory clause in par. (2), and former pars. (2)(A)(i) and (ii) as pars. (2)(A) and (B), and struck out ‘‘(A)’’ after ‘‘(2)’’. Statutory Notes and Related Subsidiaries PERSONS CONVICTED OF SUBVERSIVE ACTIVITIES Pub. L. 89–97, title I, § 104(b)(2), July 30, 1965, 79 Stat. 334, provided that: ‘‘An individual who has been con- victed of any offense under (A) chapter 37 [section 792 et seq. of Title 18, Crimes and Criminal Procedure] (re- lating to espionage and censorship), chapter 105 [sec- tion 2151 et seq. of Title 18] (relating to sabotage), or chapter 115 [section 2381 et seq. of Title 18] (relating to treason, sedition, and subversive activities) of title 18 of the United States Code, or (B) section 4, 112, or 113 of the Internal Security Act of 1950, as amended [sec- tion 783, 822, or 823 of Title 50, War and National De- fense], may not enroll under part B of title XVIII of the Social Security Act [42 U.S.C. 1395j et seq.].’’ § 1395p. Enrollment periods (a) Generally; regulations An individual may enroll in the insurance pro- gram established by this part only in such man- ner and form as may be prescribed by regula- tions, and only during an enrollment period pre- scribed in or under this section. (b) Repealed. Pub. L. 96–499, title IX, § 945(a), Dec. 5, 1980, 94 Stat. 2642 (c) Initial general enrollment period; eligible in- dividuals before March 1, 1966 In the case of individuals who first satisfy paragraph (1) or (2) of section 1395o(a) of this