42 U.S.C. § 1395q — Coverage period

Page 3177 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1395q subsections (b) 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.’’ Pub. L. 99–272, title IX, § 9219(a)(3)(B), Apr. 7, 1986, 100 Stat. 182, provided that: ‘‘(i) The amendments made by paragraph (2) [amend- ing 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 sec- tion 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 effec- tive 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 Pub. L. 98–369, div. B, title III, § 2338(d)(2), July 18, 1984, 98 Stat. 1093, provided that: ‘‘(A) The amendments made by subsections (b) 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 pe- riod 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(b)(10) of Pub. L. 98–369 ef- fective July 18, 1984, but not to be construed as chang- ing or affecting any right, liability, status, or interpre- tation which existed (under the provisions of law in- volved) before that date, see section 2354(e)(1) of Pub. L. 98–369, set out as a note under section 1320a–1 of this title. EFFECTIVE DATE OF 1981 AMENDMENT Pub. L. 97–35, title XXI, § 2151(b), Aug. 13, 1981, 95 Stat. 802, provided that: ‘‘The amendments made by this sec- tion [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 Pub. L. 96–499, title IX, § 945(d), Dec. 5, 1980, 94 Stat. 2642, provided that: ‘‘The amendments made by sub- sections (a), (b), and (c) [amending this section and sec- tions 1395q and 1395r of this title] shall apply to enroll- ments occurring on or after April 1, 1981.’’ Amendment by Pub. L. 96–265 applicable with respect to hospital insurance or supplementary medical insur- ance 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 Pub. L. 96–265, set out as a note under section 426 of this title. EFFECTIVE DATE OF 1972 AMENDMENT Pub. L. 92–603, title II, § 259(b), Oct. 30, 1972, 86 Stat. 1448, provided that: ‘‘The amendment made by sub- section (a) [amending this section] shall be effective as of July 1, 1966.’’ EFFECTIVE DATE OF 1968 AMENDMENT Pub. L. 90–248, title I, § 136(b), Jan. 2, 1968, 81 Stat. 853, provided that: ‘‘The amendment made by subsection (a) [amending this section] shall apply to individuals en- rolling under part B of title XVIII [42 U.S.C. 1395j et seq.] in months beginning after the date of the enact- ment of this Act [Jan. 2, 1968].’’ Pub. L. 90–248, title I, § 145(e), Jan. 2, 1968, 81 Stat. 859, provided that: ‘‘The amendments made by subsections (a), (b), and (c) [amending this section and section 1395q of this title] shall become effective April 1, 1968. Not- withstanding the provisions of section 2 of Public Law 90–97, the amendments made by subsection (d) [amend- ing section 1395r of this title] shall become effective December 1, 1968.’’ MEDICARE PART B SPECIAL ENROLLMENT PERIOD Pub. L. 108–173, title VI, § 625(b), 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 Sec- retary 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 pro- vided 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 en- rolls.’’ EXTENSION THROUGH MARCH 31, 1968 OF 1967 GENERAL ENROLLMENT PERIOD Pub. 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 es- tablished 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(b)(1) of this title, through Mar. 31, 1968. ENROLLMENT BEFORE OCT. 1, 1966, OF ELIGIBLE INDI- VIDUALS FAILING FOR GOOD CAUSE TO ENROLL BE- FORE JUNE 1, 1966; COMMENCEMENT OF COVERAGE PE- RIOD Pub. L. 89–97, title I, § 102(b), July 30, 1965, 79 Stat. 332, as amended by Pub. L. 89–384, § 3(c), Apr. 8, 1966, 80 Stat. 105, provided that: ‘‘If— ‘‘(1) an individual was eligible to enroll under sec- tion 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 pre- ceding sentence shall be made in accordance with regu- lations 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 en- rolls.’’ § 1395q. Coverage period (a) Commencement The period during which an individual is enti- tled to benefits under the insurance program es- tablished 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 en- rolls pursuant to subsection (d) of section Page 3178 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1395q 1395p of this title 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 sat- isfies such paragraph in a month beginning be- fore 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 sat- isfies such paragraph in a month beginning on or after January 1, 2023, and who enrolls pur- suant to such subsection (d) in such month in which he first satisfies such paragraph or in any subsequent month of his initial enroll- ment period, the first day of the month fol- lowing 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 in a month beginning— (i) before January 1, 2023, the July 1 fol- lowing 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, which- ever 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 pre- scribed 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 insur- ance 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) take effect at the close of the month following the month in which the notice is filed. The termination of a cov- erage period under paragraph (2) shall take ef- fect 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 ex- tended to not to exceed 180 days in any case where the Secretary determines that there was good cause for failure to pay the overdue pre- miums within such 90-day period. Where an individual who is deemed to have en- rolled for medical insurance pursuant to section 1395p(f) of this title or section 1395p(n)(3) of this title files a notice before the first day of the month in which his coverage period begins ad- vising 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 or section 1395p(n)(3) of this title files a notice requesting termination of his deemed coverage in or after the month in which such coverage be- comes effective, the termination of such cov- erage 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 para- graph (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 pe- riod (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 cov- erage period No payments may be made under this part with respect to the expenses of an individual un- less such expenses were incurred by such indi- vidual during a period which, with respect to him, is a coverage period. (e) Commencement of coverage for special en- rollment periods Notwithstanding subsection (a), in the case of an individual who enrolls during a special en- rollment 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 or specified in section 1395p(i)(4)(A)(i) of this title) 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 enroll- ment 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 volun- teers serving outside United States Notwithstanding subsection (a), in the case of an individual who enrolls during a special en- rollment period pursuant to section 1395p(k) of this title, the coverage period shall begin on the Page 3179 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1395q 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 en- rollment period pursuant to section 1395p(m) of this title, the coverage period shall begin on a date the Secretary provides in a manner con- sistent (to the extent practicable) with pro- tecting 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 sec- tion 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, such individual’s cov- erage 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 en- rolls (or reenrolls, if applicable) in part B for coverage of immunosuppressive drugs under paragraph (2) or (4) of section 1395p(n) of this title, such individual’s coverage period shall begin on January 1, 2023, or the month fol- lowing 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 de- scribed 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 sub- section (a) or (b) of section 426 of this title, or under section 426–1 of this title, or is no longer eligible for such coverage as a result of the ap- plication of section 1395o(b)(2) of this title. (5) The Secretary may conduct public edu- cation activities to raise awareness of the availability of more comprehensive, individual health insurance coverage (as defined in sec- tion 300gg–91 of this title) for individuals eligi- ble under section 1395o(b) of this title to enroll or to be deemed enrolled in the medical insur- ance program established under this part for purposes of coverage of immunosuppressive drugs. (i) Coverage period for certain Postal Service an- nuitants and family members Notwithstanding subsection (a), in the case of an individual who enrolls during the special en- rollment period pursuant to section 1395p(o) of this title, the coverage period shall begin on January 1, 2025. (Aug. 14, 1935, ch. 531, title XVIII, § 1838, as added Pub. L. 89–97, title I, § 102(a), July 30, 1965, 79 Stat. 305; amended Pub. L. 90–248, title I, § 145(c), Jan. 2, 1968, 81 Stat. 859; Pub. L. 92–603, title II, §§ 201(c)(3), 206(b), (c), 257(a), Oct. 30, 1972, 86 Stat. 1373, 1378, 1447; Pub. L. 96–499, title IX, §§ 945(c)(1), 947(b), Dec. 5, 1980, 94 Stat. 2642, 2643; Pub. L. 97–35, title XXI, §§ 2106(b)(2), 2151(a)(3), Aug. 13, 1981, 95 Stat. 792, 802; Pub. L. 98–369, div. B, title III, § 2338(c), July 18, 1984, 98 Stat. 1092; Pub. L. 99–272, title IX, § 9201(c)(2), Apr. 7, 1986, 100 Stat. 171; Pub. L. 99–509, title IX, § 9344(b)(1), Oct. 21, 1986, 100 Stat. 2042; Pub. L. 103–432, title I, § 147(f)(1)(B), Oct. 31, 1994, 108 Stat. 4430; Pub. L. 105–33, title IV, § 4581(b)(2), Aug. 5, 1997, 111 Stat. 465; Pub. L. 108–173, title VII, § 736(b)(6), Dec. 8, 2003, 117 Stat. 2356; Pub. L. 109–171, title V, § 5115(a)(2)(B), Feb. 8, 2006, 120 Stat. 46; Pub. L. 116–260, div. CC, title I, § 120(a)(1), (2)(B), title IV, § 402(a)(2)(B)(i), (c), Dec. 27, 2020, 134 Stat. 2953, 2954, 2999, 3000; Pub. L. 117–108, title I, § 101(b)(2)(B), Apr. 6, 2022, 136 Stat. 1136.) Editorial Notes AMENDMENTS 2022—Subsec. (i). Pub. L. 117–108 added subsec. (i). 2020—Subsec. (a)(2). Pub. L. 116–260, § 120(a)(1)(A), amended par. (2) generally. Prior to amendment, par. (2) related to coverage period for individuals enrolling pursuant to section 1395p(d) of this title. Subsec. (a)(3). Pub. L. 116–260, § 120(a)(1)(B), amended par. (3) generally. Prior to amendment, par. (3) read as follows: ‘‘(A) in the case of an individual who is deemed to have enrolled 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 re- quirements of section 1395o of this title or July 1, 1973, whichever is later, or ‘‘(B) in the case of an individual who is deemed to have enrolled on or after the first day of the fourth month of his initial enrollment period, as prescribed under subparagraphs (B), (C), (D), and (E) of paragraph (2) of this subsection.’’ Subsec. (b). Pub. L. 116–260, § 402(c)(2), inserted in con- cluding provisions ‘‘or section 1395p(n)(3) of this title’’ after ‘‘section 1395p(f) of this title’’ in two places. Subsec. (c). Pub. L. 116–260, § 402(a)(2)(B)(i), sub- stituted ‘‘section 1395o(a) of this title’’ for ‘‘section 1395o of this title’’. Subsec. (g). Pub. L. 116–260, § 120(a)(2)(B), added sub- sec. (g). Subsec. (h). Pub. L. 116–260, § 402(c)(1), added subsec. (h). 2006—Subsec. (f). Pub. L. 109–171 added subsec. (f). 2003—Subsec. (a)(1). Pub. L. 108–173 inserted comma after ‘‘1966’’. 1997—Subsec. (e). Pub. L. 105–33 inserted ‘‘or 1395p(i)(4)(B)’’ after ‘‘1395p(i)(3)’’ in introductory provi- sions and ‘‘or specified in section 1395p(i)(4)(A)(i) of this title’’ after ‘‘1395p(i)(3) of this title’’ in par. (1). 1994—Subsec. (e). Pub. L. 103–432 amended pars. (1) and (2) generally. Prior to amendment, pars. (1) and (2) read as follows: ‘‘(1) in the first month of the special enrollment pe- riod, the coverage period shall begin on the first day of that month, or ‘‘(2) in a month after the first 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.’’ 1986—Subsec. (b). Pub. L. 99–509 substituted ‘‘month following the month’’ for ‘‘calendar quarter following the calendar quarter’’ in second and sixth sentences. Subsec. (e). Pub. L. 99–272 amended subsec. (e) gen- erally. Prior to amendment, subsec. (e) read as follows: ‘‘Notwithstanding subsection (a) of this section, in the case of an individual who enrolls during a special en- rollment period pursuant to— ‘‘(1) subparagraph (A) of section 1395p(i)(3) of this title— ‘‘(A) before the month in which he attains the age of 70, the coverage period shall begin on the first day of the month in which he has attained the age of 70, or ‘‘(B) in or after the month in which he attains the age of 70, the coverage period shall begin on the Page 3180 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1395q first day of the month following the month in which he so enrolls; or ‘‘(2) subparagraph (B) of section 1395p(i)(3) of this title— ‘‘(A) in the first month of the special enrollment period, the coverage period shall begin on the first day of such month, or ‘‘(B) in a month after the first month of the spe- cial enrollment period, the coverage period shall begin on the first day of the month following the month in which he so enrolls.’’ 1984—Subsec. (e). Pub. L. 98–369, § 2338(c), added sub- sec. (e). 1981—Subsec. (a)(2)(E). Pub. L. 97–35, § 2151(a)(3), sub- stituted ‘‘the July 1 following’’ for ‘‘the first day of the third month following’’. Subsec. (b). Pub. L. 97–35, § 2106(b)(2), struck out pro- vision that notice filed by an individual enrolled pursu- ant to section 1395p(f) of this title shall not be consid- ered a disenrollment for purposes of section 1395p(b) of this title. 1980—Subsec. (a)(2)(E). Pub. L. 96–499, § 945(c)(1), sub- stituted ‘‘the first day of the third month’’ for ‘‘the July 1’’. Subsec. (b). Pub. L. 96–499, § 947(b), inserted ‘‘(except as otherwise provided in section 1395v(e) of this title)’’. 1972—Subsec. (a)(1). Pub. L. 92–603, § 201(c)(3)(A), in- serted ‘‘or (in the case of a disabled individual who has not attained age 65) July 1, 1973’’ after ‘‘July 1, 1966’’. Subsec. (a)(2). Pub. L. 92–603, § 201(c)(3)(B), substituted in subpar. (A) ‘‘paragraph (1) or (2)’’ for ‘‘paragraphs (1) and (2)’’ and in subpars. (B) to (D) ‘‘paragraph’’ for ‘‘paragraphs’’. Subsec. (a)(3). Pub. L. 92–603, § 206(b), added par. (3). Subsec. (b). Pub. L. 92–603, §§ 206(c), 257(a), inserted provisions relating to an individual who is deemed to have enrolled for medical insurance pursuant to section 1395p(f) of this title and an individual who is deemed enrolled for medical insurance benefits pursuant to sec- tion 1395p(f) of this title and struck out provisions lim- iting the allowable grace period to 90 days and inserted provision for extension of such period of up to 180 days where failure to pay premiums is due to good cause. Subsecs. (c), (d). Pub. L. 92–603, § 202(c)(3)(C), added subsec. (c) and redesignated former subsec. (c) as (d). 1968—Subsec. (b). Pub. L. 90–248 struck out ‘‘, during a general enrollment period described in section 1395p(e) of this title,’’ after ‘‘notice’’ in par. (1), and substituted in first sentence following par. (2) ‘‘the cal- endar quarter following the calendar quarter’’ for ‘‘De- cember 31 of the year’’. Statutory Notes and Related Subsidiaries EFFECTIVE DATE OF 2006 AMENDMENT Amendment by Pub. L. 109–171 effective Jan. 1, 2007, see section 5115(b) of Pub. L. 109–171, set out as a note under section 1395p of this title. EFFECTIVE DATE OF 1997 AMENDMENT Amendment by Pub. L. 105–33 applicable to involun- tary terminations of coverage under a group health plan occurring on or after Aug. 5, 1997, see section 4581(c) of Pub. L. 105–33, set out as a note under section 1395p of this title. EFFECTIVE DATE OF 1994 AMENDMENT Amendment by Pub. L. 103–432 effective on first day of first month beginning after expiration of the 120-day period that begins on Oct. 31, 1994, see section 147(f)(1)(C) of Pub. L. 103–432, set out as a note under section 1395p of this title. EFFECTIVE DATE OF 1986 AMENDMENT Pub. L. 99–509, title IX, § 9344(b)(2), Oct. 21, 1986, 100 Stat. 2042, provided that: ‘‘The amendments made by paragraph (1) [amending this section] shall apply to no- tices filed on or after July 1, 1987.’’ Amendment by Pub. L. 99–272 effective May 1, 1986, see section 9201(d)(2) of Pub. L. 99–272, set out as a note under section 1395p of this title. EFFECTIVE DATE OF 1984 AMENDMENT For effective date of amendment by Pub. L. 98–369, see section 2338(d)(2) of Pub. L. 98–369, set out as a note under section 1395p of this title. EFFECTIVE DATE OF 1981 AMENDMENT Amendment by section 2106(b)(2) of Pub. L. 97–35 ef- fective Apr. 1, 1981, see section 2106(c) of Pub. L. 97–35, set out as a note under section 1395l of this title. Amendment by section 2151(a)(3) of Pub. L. 97–35 not applicable to enrollments pursuant to written requests for enrollment filed before Oct. 1, 1981, see section 2151(b) of Pub. L. 97–35, set out as a note under section 1395p of this title. EFFECTIVE DATE OF 1980 AMENDMENT Amendment by section 945(c)(1) of Pub. L. 96–499 ap- plicable to enrollments occurring on or after Apr. 1, 1981, see section 945(d) of Pub. L. 96–499, set out as a note under section 1395p of this title. Amendment by section 947(b) of Pub. L. 96–499 appli- cable to notices filed after third calendar month begin- ning after Dec. 5, 1980, see section 947(d) of Pub. L. 96–499, set out as a note under section 1395v of this title. EFFECTIVE DATE OF 1972 AMENDMENT Pub. L. 92–603, title II, § 257(b), Oct. 30, 1972, 86 Stat. 1447, provided that: ‘‘The amendments made by sub- section (a) [amending this section] shall apply with re- spect to nonpayment of premiums which become due and payable on or after the date of the enactment of this Act [Oct. 30, 1972] or which became payable within the 90-day period immediately preceding such date; and for purposes of such amendments any premium which became due and payable within such 90-day period shall be considered a premium becoming due and payable on the date of the enactment of this Act.’’ EFFECTIVE DATE OF 1968 AMENDMENT Amendment by Pub. L. 90–248 effective Apr. 1, 1968, see section 145(e) of Pub. L. 90–248, set out as a note under section 1395p of this title. COVERAGE PERIOD; TERMINATION DATES Pub. L. 90–97, § 3(a), Sept. 30, 1967, 81 Stat. 249, pro- vided that: ‘‘In the case of any individual who, pursu- ant to section 1838(b)(1) of the Social Security Act [42 U.S.C. 1395q(b)(1)], terminates his enrollment in the in- surance program established under part B of title XVIII of such Act [42 U.S.C. 1395j et seq.], his coverage period (as defined in section 1838(a) of such Act) [42 U.S.C. 1395q(a)]— ‘‘(1) shall terminate at the close of December 31, 1967, if he filed his notice of termination before Janu- ary 1, 1968, or ‘‘(2) shall terminate at the close of March 31, 1968, if he filed his notice of termination after December 31, 1967, and before April 1, 1968. An individual whose coverage period terminated pursu- ant to paragraph (1) at the close of December 31, 1967, may, notwithstanding section 1837(b)(2) of such Act [42 U.S.C. 1395p(b)(2)], enroll in such program before April 1, 1968, and for purposes of sections 1838(a)(2)(E) [42 U.S.C. 1395q(a)(2)(E)] and 1837(b)(2) of such Act [42 U.S.C. 1395p(b)(2)] such enrollment shall be deemed an enrollment under section 1837(e) of such Act [42 U.S.C. 1395p(e)] and a second enrollment under such part.’’ EXTENSION OF 1967 GENERAL ENROLLMENT PERIOD THROUGH MARCH 31, 1968 Extension of the general enrollment period under sec- tion 1395p(e) of this title through March 31, 1968, see section 1 of Pub. L. 90–97, Sept. 30, 1967, 81 Stat. 249, set out as a note under section 1395p of this title. COVERAGE PERIOD FOR INDIVIDUALS BECOMING ELIGIBLE IN MARCH 1966 WHO ENROLL IN MAY 1966 Pub. L. 89–384, § 3(d), Apr. 8, 1966, 80 Stat. 105, provided that: ‘‘In the case of an individual who first satisfies Page 3181 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1395r paragraphs (1) and (2) of section 1836 of the Social Secu- rity Act [42 U.S.C. 1395o] in March, 1966, and who en- rolls pursuant to subsection (d) of section 1837 of such Act [42 U.S.C. 1395p] in May 1966, his coverage period shall, notwithstanding section 1838(a)(2)(D) of such Act [42 U.S.C. 1395q(a)(2)(D)], begin on July 1, 1966.’’ COMMENCEMENT OF COVERAGE PERIOD OF CERTAIN ENROLLEES Commencement of coverage period upon enrollment before Oct. 1, 1966 of eligible individuals failing for good cause to enroll before June 1, 1966, see section 102(b) of Pub. L. 89–97, set out as a note under section 1395p of this title. § 1395r. Amount of premiums for individuals en- rolled under this part (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 Med- ical Insurance Trust Fund for services per- formed and related administrative costs in- curred in such calendar year with respect to such enrollees. In calculating the monthly actu- arial rate, the Secretary shall include an appro- priate amount for a contingency margin. In ap- plying 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. (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 ac- cordance 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. (3) The Secretary, during September of each year, shall determine and promulgate a monthly premium rate for the succeeding calendar year that (except as provided in subsection (g)) is equal to 50 percent of the monthly actuarial rate for enrollees age 65 and over, determined according to paragraph (1), for that succeeding calendar year. Whenever the Secretary promul- gates the dollar amount which shall be applica- ble as the monthly premium rate for any period, he shall, at the time such promulgation is an- nounced, issue a public statement setting forth the actuarial assumptions and bases employed by him in arriving at the amount of an adequate actuarial rate for enrollees age 65 and older as provided in paragraph (1). (4) The Secretary shall also, during September of 1983 and of each year thereafter, determine the monthly actuarial rate for disabled enrollees under age 65 which shall be applicable for the succeeding calendar year. 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 disabled en- rollees under age 65 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 admin- istrative costs incurred in such calendar year with respect to such enrollees. In calculating the monthly actuarial rate under this para- graph, the Secretary shall include an appro- priate amount for a contingency margin. (5)(A) In applying this part (including sub- section (i) and section 1395l(b) of this title), the monthly actuarial rate for enrollees age 65 and over for 2016 shall be determined as if subsection (f) did not apply. (B) Subsection (f) shall continue to be applied to paragraph (6)(A) (during a repayment month, as described in paragraph (6)(B)) and without re- gard to the application of subparagraph (A). (6)(A) With respect to a repayment month (as described in subparagraph (B)), the monthly pre- mium otherwise established under paragraph (3) shall be increased by, subject to subparagraph (D), $3. (B) For purposes of this paragraph, a repay- ment month is a month during a year, beginning with 2016, for which a balance due amount is computed under subparagraph (C) as greater than zero. (C) For purposes of this paragraph, the balance due amount computed under this subparagraph, with respect to a month, is the amount esti- mated by the Chief Actuary of the Centers for Medicare & Medicaid Services to be equal to— (i) the amount transferred under subsections (d)(1) and (e)(1) of section 1395w of this title; plus (ii) the amount that is equal to the aggre- gate reduction, for all individuals enrolled under this part, in the income related monthly adjustment amount as a result of the applica- tion of paragraphs (5) and (7); minus (iii) the amounts payable under this part as a result of the application of this paragraph for preceding months. (D) If the balance due amount computed under subparagraph (C), without regard to this sub- paragraph, for December of a year would be less than zero, the Chief Actuary of the Centers for Medicare & Medicaid Services shall estimate, and the Secretary shall apply, a reduction to the dollar amount increase applied under subpara- graph (A) for each month during such year in a manner such that the balance due amount for January of the subsequent year is equal to zero. (7)(A) In applying this part (including sub- section (i) and section 1395l(b) of this title), the monthly actuarial rate for enrollees age 65 and over for 2021 shall be determined to be equal to the sum of— (i) the monthly actuarial rate for enrollees age 65 and over for 2020; plus (ii) 25 percent of the difference between such rate for 2020 and the preliminary monthly ac- tuarial rate for enrollees age 65 and over for 2021 (as estimated under subparagraph (B)). (B) For purposes of subparagraph (A)(ii), the Secretary shall estimate a preliminary monthly actuarial rate for enrollees age 65 and over for