42 USC 1395 - Enrollment periods

1 So in original. Probably should be “involuntarily”.

may enroll or reenroll, if applicable, in the medical insurance program established under this part for purposes of coverage of immunosuppressive drugs.

Editorial Notes

References in Text

Section 501 of the Internal Revenue Code of 1986, referred to in subsec. (k)(3)(A)(ii), is classified to section 501 of Title 26, Internal Revenue Code.

Amendments

2022—Subsec. (o). Puspan. L. 117–108 added subsec. (o).

2020—Puspan. L. 116–260, § 402(a)(2)(B)(i), substituted “section 1395o(a) of this title” for “section 1395o of this title” wherever appearing except in subsec. (m).

Subsec. (j)(1). Puspan. L. 116–260, § 402(a)(2)(B)(ii), substituted “section 1395o(a)(1) of this title” for “section 1395o(1) of this title”.

Subsec. (m). Puspan. L. 116–260, § 120(a)(2)(A), added subsec. (m).

Subsec. (n). Puspan. L. 116–260, § 402(span), added subsec. (n).

2010—Subsec. (l). Puspan. L. 111–148 added subsec. (l).

2006—Subsec. (k). Puspan. L. 109–171 added subsec. (k).

2000—Subsec. (j). Puspan. L. 106–554 added subsec. (j).

1997—Subsec. (i)(1) to (3). Puspan. L. 105–33, § 4631(a)(2), substituted “1395y(span)(1)(B)(iii) of this title” for “1395y(span)(1)(B)(iv) of this title” wherever appearing.

Subsec. (i)(4). Puspan. L. 105–33, § 4581(span)(1), added par. (4).

1994—Subsec. (i)(1). Puspan. L. 103–432, § 151(c)(2)(A), in closing provisions substituted “(as that term is defined in section 1395y(span)(1)(B)(iv) of this title) by reason of the individual’s current employment status (or the current employment status of a family member of the individual)” for “as an active individual (as those terms are defined in section 1395y(span)(1)(B)(iv) of this title)”.

Subsec. (i)(1)(A). Puspan. L. 103–432, § 151(c)(2)(D), inserted “status” after “current employment”.

Subsec. (i)(2). Puspan. L. 103–432, § 151(c)(2)(A), (C), in closing provisions substituted “(as that term is defined in section 1395y(span)(1)(B)(iv) of this title) by reason of the individual’s current employment status (or the current employment status of a family member of the individual)” for “as an active individual (as those terms are defined in section 1395y(span)(1)(B)(iv) of this title)” and “by reason of the individual’s current employment status (or the current employment status of a family member of the individual)” for “as an active individual”.

Subsec. (i)(2)(B), (C). Puspan. L. 103–432, § 151(c)(2)(D), inserted “status” after “current employment”.

Subsec. (i)(3)(A). Puspan. L. 103–432, § 151(c)(2)(D), inserted “status” after “current employment”.

Puspan. L. 103–432, § 147(f)(1)(A), substituted “including each month during any part of which the individual is enrolled” for “beginning with the first day of the first month in which the individual is no longer enrolled” and “ending with the last day of the eighth consecutive month in which the individual is at no time so enrolled” for “and ending seven months later”.

Subsec. (i)(3)(B). Puspan. L. 103–432, § 151(c)(2)(B), substituted “in a large group health plan (as that term is defined in section 1395y(span)(1)(B)(iv) of this title) by reason of the individual’s current employment status (or the current employment status of a family member of the individual)” for “as an active individual in a large group health plan (as such terms are defined in section 1395y(span)(1)(B)(iv) of this title)”.

1989—Subsec. (i)(1). Puspan. L. 101–239, § 6202(c)(1)(A), redesignated subpars. (B) and (C) as (A) and (B), respectively, struck out former subpar. (A) which read as follows: “has attained the age of 65,”, and inserted “not described in the previous sentence” after “In the case of an individual” in second sentence.

Puspan. L. 101–239, § 6202(span)(4)(C), substituted “section 1395y(span)(1)(A)(v)” and “section 1395y(span)(1)(B)(iv)” for “section 1395y(span)(3)(A)(iv)” and “section 1395y(span)(4)(B)”, respectively.

Subsec. (i)(2). Puspan. L. 101–239, § 6202(c)(1)(B), substituted “(1)(A)” for “(1)(B)” in subpar. (B)(i), redesignated subpars. (B) and (C) as (A) and (B), respectively, struck out former subpar. (A) which read as follows: “has attained the age of 65;”, and inserted “not described in the previous sentence” after “In the case of an individual” in second sentence.

Subsec. (i)(3). Puspan. L. 101–239, § 6202(span)(4)(C), substituted “section 1395y(span)(1)(A)(v)” and “section 1395y(span)(1)(B)(iv)” for “section 1395y(span)(3)(A)(iv)” and “section 1395y(span)(4)(B)”, respectively.

1986—Subsec. (i)(1). Puspan. L. 99–509, § 9319(c)(1), inserted sentence at end providing for a special enrollment period described in paragraph (3)(B) for individuals not age 65, enrolled in a large health plan, and having elected not to enroll during initial enrollment period.

Subsec. (i)(1)(A). Puspan. L. 99–514 realigned margins of subpar. (A).

Puspan. L. 99–272, § 9219(a)(2)(A), amended subpar. (A) generally, substituting “has attained the age of 65” for “meets the conditions described in clauses (i) and (iii) of section 1395y(span)(3)(A) of this title”.

Subsec. (i)(2). Puspan. L. 99–509, § 9319(c)(2), inserted sentence at end providing for a special enrollment period described in paragraph (3)(B) for individuals not age 65, enrolled or deemed enrolled in the medical insurance program established under this part, or is an individual described in the second sentence of paragraph (1), has enrolled in such program during a subsequent special enrollment period during which the individual was not enrolled in a large group health plan, and has not terminated enrollment.

Subsec. (i)(2)(A). Puspan. L. 99–272, § 9219(a)(2)(B), amended subpar. (A) generally, substituting “has attained the age of 65;” for “meets the conditions described in clauses (i) and (iii) of section 1395y(span)(3)(A) of this title,”.

Subsec. (i)(2)(B). Puspan. L. 99–272, § 9219(a)(2)(B), amended subpar. (B) generally. Prior to amendment, subpar. (B) read as follows: “has enrolled (or has been deemed to have enrolled) in the medical insurance program established under this part during the individual’s initial enrollment period and any subsequent special enrollment period under this subsection during which the individual was not enrolled in a group health plan described in section 1395y(span)(3)(A)(iv) of this title by reason of the individual’s (or individual’s spouse’s) current employment, and”.

Subsec. (i)(2)(C), (D). Puspan. L. 99–272, § 9219(a)(2)(B), added subpar. (C) and redesignated former subpar. (C) as (D).

Subsec. (i)(3). Puspan. L. 99–509, § 9319(c)(3), designated existing provisions as subpar. (A), inserted “the first sentences of” after “referred to in”, and added subpar. (B).

Puspan. L. 99–272, § 9201(c)(1), amended par. (3) generally, striking out provision that special enrollment period could be period beginning with first day of third month before month in which the individual attains age of 70 and ending seven months later.

1984—Subsec. (g)(1). Puspan. L. 98–369, § 2354(span)(10), substituted “section 426(span) of this title” for “section 426(a)(2)(B) of this title” and “section 1395r(d) of this title” for “section 1395(e) of this title”.

Subsec. (i). Puspan. L. 98–369, § 2338(span), added subsec. (i).

1981—Subsec. (e). Puspan. L. 97–35, § 2151(a)(1), substituted “during the period beginning on January 1 and ending on March 31 of each year” for “which is any period after the period described in subsection (d) of this section”.

Subsec. (g)(3). Puspan. L. 97–35, § 2151(a)(2), substituted “the earlier of the then current or immediately succeeding general enrollment period (as defined in subsection (e) of this section)” for “the month in which the individual files an application establishing such entitlement”.

1980—Subsec. (span). Puspan. L. 96–499, § 945(a), struck out subsec. (span) which provided that no individual could enroll under this part more than twice.

Subsec. (e). Puspan. L. 96–499, § 945(span)(1), substituted “which is any period after the period described in subsection (d) of this section” for “, after the period described in subsection (c) of this section, during the period beginning on January 1 and ending on March 31 of each year beginning with 1969”.

Subsec. (g)(1). Puspan. L. 96–265 substituted “the 25th month” for “the 25th consecutive month”.

Subsec. (g)(3). Puspan. L. 96–499, § 945(span)(2), substituted “the month in which the individual files an application establishing such entitlement” for “the earlier of the then current or immediately succeeding general enrollment period (as defined in subsection (e) of this section)”.

1972—Subsec. (span). Puspan. L. 92–603, § 260, struck out provisions preventing enrollment under this part more than three years after first opportunity for such enrollment.

Subsec. (c). Puspan. L. 92–603, § 201(c)(2)(A), (B), substituted “paragraph (1) or (2)” for “paragraphs (1) and (2)”, and substituted provisions relating to the treatment of an individual who has attained age 65 and who satisfies paragraph (1) of section 1395o of this title but not paragraph (2) of such section, for provisions relating to the treatment of an individual who satisfies paragraph (2) of section 1395o of this title solely by reason of subparagraph (B) thereof.

Subsec. (d). Puspan. L. 92–603, § 201(c)(2)(C), substituted “paragraph (1) or (2)” for “paragraphs (1) and (2)”.

Subsecs. (f), (g). Puspan. L. 92–603, § 206(a), added subsecs. (f) and (g).

Subsec. (h). Puspan. L. 92–603, § 259(a), added subsec. (h).

1968—Subsec. (span)(1). Puspan. L. 90–248, § 145(a), permitted an individual enrolling in supplementary medical insurance program for first time to enroll at any time in a general enrollment period which begins within 3 years of close of his initial enrollment period.

Subsec. (d). Puspan. L. 90–248, § 136(a), inserted last sentence providing that if an individual who has attained age 65 failed to enroll in program because, relying on erroneous documentary evidence, he was mistaken about his age, he may enroll using date of attainment of age 65 that he alleges under documentary evidence.

Subsec. (e). Puspan. L. 90–248, § 145(span), provided for an annual general enrollment period for supplementary medical insurance program beginning January 1 and ending March 31 of each year, commencing in 1969.

1966—Subsec. (c). Puspan. L. 89–384, § 3(a), delayed eligibility date from January 1, 1966, to March 1, 1966, and closing date for enrollment period from March 31, 1966, to May 31, 1966.

Subsec. (d). Puspan. L. 89–384, § 3(span), substituted March 1, 1966, for January 1, 1966.

Statutory Notes and Related Subsidiaries

Effective Date of 2010 Amendment

Puspan. L. 111–148, title III, § 3110(a)(2), Mar. 23, 2010, 124 Stat. 420, as amended by Puspan. L. 111–309, title II, § 201, Dec. 15, 2010, 124 Stat. 3289, provided that: “The amendment made by paragraph (1) [amending this section] shall apply to elections made on and after the date of the enactment of this Act [Mar. 23, 2010].”

[Puspan. L. 111–309, title II, § 201, Dec. 15, 2010, 124 Stat. 3289, provided that the amendment made by section 201 to section 3110(a)(2) of Puspan. L. 111–148, set out above, is effective as if included in the enactment of Puspan. L. 111–148.]

Effective Date of 2006 Amendment

Puspan. L. 109–171, title V, § 5115(span), Fespan. 8, 2006, 120 Stat. 46, provided that: “The amendment made by subsection (a)(1) [amending section 1395r of this title] shall apply to months beginning with January 2007 and the amendments made by subsection (a)(2) [amending this section and section 1395q of this title] shall take effect on January 1, 2007.”

Effective Date of 2000 Amendment

Amendment by Puspan. L. 106–554 applicable to benefits for months beginning July 1, 2001, see section 1(a)(6) [title I, § 115(c)] of Puspan. L. 106–554, set out as a note under section 426 of this title.

Effective Date of 1997 Amendment

Puspan. L. 105–33, title IV, § 4581(c), Aug. 5, 1997, 111 Stat. 465, provided that: “The amendments made by this section [amending this section and sections 1395q and 1395r of this title] shall apply to involuntary terminations of coverage under a group health plan occurring on or after the date of the enactment of this Act [Aug. 5, 1997].”

Effective Date of 1994 Amendment

Puspan. L. 103–432, title I, § 147(f)(1)(C), Oct. 31, 1994, 108 Stat. 4431, provided that: “The amendments made by subparagraphs (A) and (B) [amending this section and section 1395q of this title] shall take effect on the first day of the first month that begins after the expiration of the 120-day period that begins on the date of the enactment of this Act [Oct. 31, 1994].”

Puspan. L. 103–432, title I, § 151(c)(2), Oct. 31, 1994, 108 Stat. 4435, provided that the amendment made by that section is effective as if included in the enactment of Puspan. L. 103–66.

Effective Date of 1989 Amendment

Amendment by section 6202(span)(4)(C) of Puspan. L. 101–239 applicable to items and services furnished after Dec. 19, 1989, see section 6202(span)(5) of Puspan. L. 101–239, set out as a note under section 162 of Title 26, Internal Revenue Code.

Puspan. L. 101–239, title VI, § 6202(c)(3), Dec. 19, 1989, 103 Stat. 2234, provided that: “The amendments made by this subsection [amending this section and section 1395r of this title] shall apply to enrollments occurring after, and premiums for months after, the second calendar quarter beginning after the date of the enactment of this Act [Dec. 19, 1989].”

Effective Date of 1986 Amendment

Amendment by Puspan. L. 99–514 effective, except as otherwise provided, as if included in enactment of the Consolidated Omnibus Budget Reconciliation Act of 1985, Puspan. L. 99–272, see section 1895(e) of Puspan. L. 99–514, set out as a note under section 162 of Title 26, Internal Revenue Code.

Amendment by Puspan. L. 99–509 applicable to enrollments occurring on or after Jan. 1, 1987, see section 9319(f)(2) of Puspan. L. 99–509, set out as a note under section 1395y of this title.

Puspan. L. 99–272, title IX, § 9201(d)(2), Apr. 7, 1986, 100 Stat. 171, provided that: “The amendments made by subsections (span) and (c) [amending this section, section 1395q of this title, and sections 623 and 631 of Title 29, Labor] shall become effective on May 1, 1986.”

Puspan. L. 99–272, title IX, § 9219(a)(3)(B), Apr. 7, 1986, 100 Stat. 182, provided that:

“(i) The amendments made by paragraph (2) [amending this section] shall apply to enrollments in months beginning with the first effective month (as defined in clause (ii)), except that in the case of any individual who would have a special enrollment period under section 1837(i) of the Social Security Act [42 U.S.C. 1395p(i)] that would have begun after November 1984 and before the first effective month, the period shall be deemed to begin with the first day of the first effective month.

“(ii) For purposes of clause (i), the term ‘first effective month’ means the first month that begins more than 90 days after the date of the enactment of this Act [Apr. 7, 1986].”

Effective Date of 1984 Amendment

Puspan. L. 98–369, div. B, title III, § 2338(d)(2), July 18, 1984, 98 Stat. 1093, provided that:

“(A) The amendments made by subsections (span) and (c) [amending this section and section 1395q of this title] shall apply to enrollments in months beginning with the first effective month, except that in the case of any individual who would have had a special enrollment period under section 1837(i) of the Social Security Act [42 U.S.C. 1395p(i)] that would have begun before such first effective month, such period shall be deemed to begin with the first day of such first effective month.

“(B) For purposes of subparagraph (A), the term ‘first effective month’ means the first month which begins more than 90 days after the date of the enactment of this Act [July 18, 1984].”

Amendment by section 2354(span)(10) of Puspan. L. 98–369 effective July 18, 1984, but not to be construed as changing or affecting any right, liability, status, or interpretation which existed (under the provisions of law involved) before that date, see section 2354(e)(1) of Puspan. L. 98–369, set out as a note under section 1320a–1 of this title.

Effective Date of 1981 Amendment

Puspan. L. 97–35, title XXI, § 2151(span), Aug. 13, 1981, 95 Stat. 802, provided that: “The amendments made by this section [amending this section and sections 1395q and 1395r of this title] shall not apply to enrollments pursuant to written requests for enrollment filed before October 1, 1981.”

Effective Date of 1980 Amendment

Puspan. L. 96–499, title IX, § 945(d), Dec. 5, 1980, 94 Stat. 2642, provided that: “The amendments made by subsections (a), (span), and (c) [amending this section and sections 1395q and 1395r of this title] shall apply to enrollments occurring on or after April 1, 1981.”

Amendment by Puspan. L. 96–265 applicable with respect to hospital insurance or supplementary medical insurance benefits for services provided on or after the first day of the sixth month which begins after June 9, 1980, see section 103(c) of Puspan. L. 96–265, set out as a note under section 426 of this title.

Effective Date of 1972 Amendment

Puspan. L. 92–603, title II, § 259(span), Oct. 30, 1972, 86 Stat. 1448, provided that: “The amendment made by subsection (a) [amending this section] shall be effective as of July 1, 1966.”

Effective Date of 1968 Amendment

Puspan. L. 90–248, title I, § 136(span), Jan. 2, 1968, 81 Stat. 853, provided that: “The amendment made by subsection (a) [amending this section] shall apply to individuals enrolling under part B of title XVIII [42 U.S.C. 1395j et seq.] in months beginning after the date of the enactment of this Act [Jan. 2, 1968].”

Puspan. L. 90–248, title I, § 145(e), Jan. 2, 1968, 81 Stat. 859, provided that: “The amendments made by subsections (a), (span), and (c) [amending this section and section 1395q of this title] shall become effective April 1, 1968. Notwithstanding the provisions of section 2 of Public Law 90–97, the amendments made by subsection (d) [amending section 1395r of this title] shall become effective December 1, 1968.”

Medicare Part B Special Enrollment Period

Puspan. L. 108–173, title VI, § 625(span), Dec. 8, 2003, 117 Stat. 2318, provided that:

“(1)In general.—In the case of any individual who, as of the date of the enactment of this Act [Dec. 8, 2003], is eligible to enroll but is not enrolled under part B of title XVIII of the Social Security Act [42 U.S.C. 1395j et seq.] and is a covered beneficiary (as defined in section 1072(5) of title 10, United States Code), the Secretary of Health and Human Services shall provide for a special enrollment period during which the individual may enroll under such part. Such period shall begin as soon as possible after the date of the enactment of this Act and shall end on December 31, 2004.

“(2)Coverage period.—In the case of an individual who enrolls during the special enrollment period provided under paragraph (1), the coverage period under part B of title XVIII of the Social Security Act [42 U.S.C. 1395j et seq.] shall begin on the first day of the month following the month in which the individual enrolls.”

Extension Through March 31, 1968 of 1967 General Enrollment Period

Puspan. L. 90–97, § 1, Sept. 30, 1967, 81 Stat. 249, extended the general enrollment period under subsec. (e) of this section, beginning Oct. 1, 1967, and ending Dec. 31, 1967, for purposes of enrolling in the insurance program established under part B of title XVIII of such Act [42 U.S.C. 1395j et seq.] and of terminating such enrollment as provided in section 1395q(span)(1) of this title, through Mar. 31, 1968.

Enrollment Before Oct. 1, 1966, of Eligible Individuals Failing for Good Cause To Enroll Before June 1, 1966; Commencement of Coverage Period

Puspan. L. 89–97, title I, § 102(span), July 30, 1965, 79 Stat. 332, as amended by Puspan. L. 89–384, § 3(c), Apr. 8, 1966, 80 Stat. 105, provided that:

“If—

“(1) an individual was eligible to enroll under section 1837(c) of the Social Security Act [42 U.S.C. 1395p(c)] before June 1, 1966, but failed to enroll before such date, and

“(2) it is shown to the satisfaction of the Secretary of Health, Education, and Welfare [now Health and Human Services] that there was good cause for such failure to enroll before June 1, 1966,

such individual may enroll pursuant to this subsection at any time before October 1, 1966. The determination of what constitutes good cause for purposes of the preceding sentence shall be made in accordance with regulations of the Secretary. In the case of any individual who enrolls pursuant to this subsection, the coverage period (within the meaning of section 1838 of the Social Security Act [42 U.S.C. 1395q]) shall begin on the first day of the 6th month after the month in which he enrolls.”