42 U.S.C. § 1395p — Enrollment periods

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 Page 3172 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1395p title before March 1, 1966, the initial general en- rollment period shall begin on the first day of the second month which begins after July 30, 1965, and shall end on May 31, 1966. For purposes of this subsection and subsection (d), an indi- vidual who has attained age 65 and who satisfies paragraph (1) of section 1395o(a) of this title but not paragraph (2) of such section shall be treat- ed as satisfying such paragraph (1) on the first day on which he is (or on filing application would have been) entitled to hospital insurance benefits under part A. (d) Eligible individuals on or after March 1, 1966 In the case of an individual who first satisfies paragraph (1) or (2) of section 1395o(a) of this title on or after March 1, 1966, his initial enroll- ment period shall begin on the first day of the third month before the month in which he first satisfies such paragraphs and shall end seven months later. Where the Secretary finds that an individual who has attained age 65 failed to en- roll under this part during his initial enrollment period (based on a determination by the Sec- retary of the month in which such individual at- tained age 65), because such individual (relying on documentary evidence) was mistaken as to his correct date of birth, the Secretary shall es- tablish for such individual an initial enrollment period based on his attaining age 65 at the time shown in such documentary evidence (with a coverage period determined under section 1395q of this title as though he had attained such age at that time). (e) General enrollment period There shall be a general enrollment period during the period beginning on January 1 and ending on March 31 of each year. (f) Individuals deemed enrolled in medical insur- ance program Any individual— (1) who is eligible under section 1395o(a) of this title to enroll in the medical insurance program by reason of entitlement to hospital insurance benefits as described in paragraph (1) of such section, and (2) whose initial enrollment period under subsection (d) begins after March 31, 1973, and (3) who is residing in the United States, ex- clusive of Puerto Rico, shall be deemed to have enrolled in the medical insurance program established by this part. (g) Commencement of enrollment period All of the provisions of this section shall apply to individuals satisfying subsection (f), except that— (1) in the case of an individual who satisfies subsection (f) by reason of entitlement to dis- ability insurance benefits described in section 426(b) of this title, his initial enrollment pe- riod shall begin on the first day of the later of (A) April 1973 or (B) the third month before the 25th month of such entitlement, and shall re- occur with each continuous period of eligi- bility (as defined in section 1395r(d) of this title) and upon attainment of age 65; (2)(A) in the case of an individual who is en- titled to monthly benefits under section 402 or 423 of this title on the first day of his initial enrollment period or becomes entitled to monthly benefits under section 402 of this title during the first 3 months of such period, his enrollment shall be deemed to have occurred in the third month of his initial enrollment period, and (B) in the case of an individual who is not entitled to benefits under section 402 of this title on the first day of his initial enrollment period and does not become so entitled during the first 3 months of such period, his enroll- ment shall be deemed to have occurred in the month in which he files the application estab- lishing his entitlement to hospital insurance benefits provided such filing occurs during the last 4 months of his initial enrollment period; and (3) in the case of an individual who would otherwise satisfy subsection (f) but does not establish his entitlement to hospital insurance benefits until after the last day of his initial enrollment period (as defined in subsection (d) of this section), his enrollment shall be deemed to have occurred on the first day of the earlier of the then current or immediately succeeding general enrollment period (as de- fined in subsection (e) of this section). (h) Waiver of enrollment period requirements where individual’s rights were prejudiced by administrative error or inaction In any case where the Secretary finds that an individual’s enrollment or nonenrollment in the insurance program established by this part or part A pursuant to section 1395i–2 of this title is unintentional, inadvertent, or erroneous and is the result of the error, misrepresentation, or in- action of an officer, employee, or agent of the Federal Government, or its instrumentalities, the Secretary may take such action (including the designation for such individual of a special initial or subsequent enrollment period, with a coverage period determined on the basis thereof and with appropriate adjustments of premiums) as may be necessary to correct or eliminate the effects of such error, misrepresentation, or inac- tion. (i) Special enrollment periods (1) In the case of an individual who— (A) at the time the individual first satisfies paragraph (1) or (2) of section 1395o(a) of this title, is enrolled in a group health plan de- scribed in section 1395y(b)(1)(A)(v) of this title by reason of the individual’s (or the individ- ual’s spouse’s) current employment status, and (B) has elected not to enroll (or to be deemed enrolled) under this section during the individ- ual’s initial enrollment period, there shall be a special enrollment period de- scribed in paragraph (3). In the case of an indi- vidual not described in the previous sentence who has not attained the age of 65, at the time the individual first satisfies paragraph (1) of sec- tion 1395o(a) of this title, is enrolled in a large group health plan (as that term is defined in sec- tion 1395y(b)(1)(B)(iii) of this title) by reason of the individual’s current employment status (or the current employment status of a family member of the individual), and has elected not Page 3173 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1395p to enroll (or to be deemed enrolled) under this section during the individual’s initial enroll- ment period, there shall be a special enrollment period described in paragraph (3)(B). (2) In the case of an individual who— (A)(i) has enrolled (or has been deemed to have enrolled) in the medical insurance pro- gram established under this part during the individual’s initial enrollment period, or (ii) is an individual described in paragraph (1)(A); (B) has enrolled in such program during any subsequent special enrollment period under this subsection during which the individual was not enrolled in a group health plan de- scribed in section 1395y(b)(1)(A)(v) of this title by reason of the individual’s (or individual’s spouse’s) current employment status; and (C) has not terminated enrollment under this section at any time at which the indi- vidual is not enrolled in such a group health plan by reason of the individual’s (or individ- ual’s spouse’s) current employment status, there shall be a special enrollment period de- scribed in paragraph (3). In the case of an indi- vidual not described in the previous sentence who has not attained the age of 65, has enrolled (or has been deemed to have enrolled) in the medical insurance program established under this part during the individual’s initial enroll- ment period, or is an individual described in the second sentence of paragraph (1), has enrolled in such program during any subsequent special en- rollment period under this subsection during which the individual was not enrolled in a large group health plan (as that term is defined in sec- tion 1395y(b)(1)(B)(iii) of this title) by reason of the individual’s current employment status (or the current employment status of a family member of the individual), and has not termi- nated enrollment under this section at any time at which the individual is not enrolled in such a large group health plan by reason of the individ- ual’s current employment status (or the current employment status of a family member of the individual), there shall be a special enrollment period described in paragraph (3)(B). (3)(A) The special enrollment period referred to in the first sentences of paragraphs (1) and (2) is the period including each month during any part of which the individual is enrolled in a group health plan described in section 1395y(b)(1)(A)(v) of this title by reason of current employment status ending with the last day of the eighth consecutive month in which the indi- vidual is at no time so enrolled. (B) The special enrollment period referred to in the second sentences of paragraphs (1) and (2) is the period including each month during any part of which the individual is enrolled in a large group health plan (as that term is defined in section 1395y(b)(1)(B)(iii) of this title) by rea- son of the individual’s current employment sta- tus (or the current employment status of a fam- ily member of the individual) ending with the last day of the eighth consecutive month in which the individual is at no time so enrolled. (4)(A) In the case of an individual who is enti- tled to benefits under part A pursuant to section 426(b) of this title and— (i) who at the time the individual first satis- fies paragraph (1) of section 1395o(a) of this title— (I) is enrolled in a group health plan de- scribed in section 1395y(b)(1)(A)(v) of this title by reason of the individual’s current or former employment or by reason of the cur- rent or former employment status of a mem- ber of the individual’s family, and (II) has elected not to enroll (or to be deemed enrolled) under this section during the individual’s initial enrollment period; and (ii) whose continuous enrollment under such group health plan is involuntarily terminated at a time when the enrollment under the plan is not by reason of the individual’s current employment or by reason of the current em- ployment of a member of the individual’s fam- ily, there shall be a special enrollment period de- scribed in subparagraph (B). (B) The special enrollment period referred to in subparagraph (A) is the 6-month period begin- ning on the first day of the month which in- cludes the date of the enrollment termination described in subparagraph (A)(ii). (j) Special rules for individuals with ALS In applying this section in the case of an indi- vidual who is entitled to benefits under part A pursuant to the operation of section 426(h) of this title, the following special rules apply: (1) The initial enrollment period under sub- section (d) shall begin on the first day of the first month in which the individual satisfies the requirement of section 1395o(a)(1) of this title. (2) In applying subsection (g)(1), the initial enrollment period shall begin on the first day of the first month of entitlement to disability insurance benefits referred to in such sub- section. (k) Special enrollment period for certain volun- teers serving outside United States (1) In the case of an individual who— (A) at the time the individual first satisfies paragraph (1) or (2) of section 1395o(a) of this title, is described in paragraph (3), and has elected not to enroll (or to be deemed enrolled) under this section during the individual’s ini- tial enrollment period; or (B) has terminated enrollment under this section during a month in which the indi- vidual is described in paragraph (3), there shall be a special enrollment period de- scribed in paragraph (2). (2) The special enrollment period described in this paragraph is the 6-month period beginning on the first day of the month which includes the date that the individual is no longer described in paragraph (3). (3) For purposes of paragraph (1), an individual described in this paragraph is an individual who— (A) is serving as a volunteer outside of the United States through a program— (i) that covers at least a 12-month period; and (ii) that is sponsored by an organization described in section 501(c)(3) of the Internal Revenue Code of 1986 and exempt from tax- ation under section 501(a) of such Code; and Page 3174 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1395p 1 So in original. Probably should be ‘‘involuntarily’’. (B) demonstrates health insurance coverage while serving in the program. (l) Special enrollment period for disabled TRICARE beneficiaries (1) In the case of any individual who is a cov- ered beneficiary (as defined in section 1072(5) of title 10) at the time the individual is entitled to part A under section 426(b) of this title or sec- tion 426–1 of this title and who is eligible to en- roll but who has elected not to enroll (or to be deemed enrolled) during the individual’s initial enrollment period, there shall be a special en- rollment period described in paragraph (2). (2) The special enrollment period described in this paragraph, with respect to an individual, is the 12-month period beginning on the day after the last day of the initial enrollment period of the individual or, if later, the 12-month period beginning with the month the individual is noti- fied of enrollment under this section. (3) In the case of an individual who enrolls during the special enrollment period provided under paragraph (1), the coverage period under this part shall begin on the first day of the month in which the individual enrolls, or, at the option of the individual, the first month after the end of the individual’s initial enrollment pe- riod. (4) An individual may only enroll during the special enrollment period provided under para- graph (1) one time during the individual’s life- time. (5) The Secretary shall ensure that the mate- rials relating to coverage under this part that are provided to an individual described in para- graph (1) prior to the individual’s initial enroll- ment period contain information concerning the impact of not enrolling under this part, includ- ing the impact on health care benefits under the TRICARE program under chapter 55 of title 10. (6) The Secretary of Defense shall collaborate with the Secretary of Health and Human Serv- ices and the Commissioner of Social Security to provide for the accurate identification of indi- viduals described in paragraph (1). The Sec- retary of Defense shall provide such individuals with notification with respect to this sub- section. The Secretary of Defense shall collabo- rate with the Secretary of Health and Human Services and the Commissioner of Social Secu- rity to ensure appropriate follow up pursuant to any notification provided under the preceding sentence. (m) Special enrollment periods for exceptional circumstances Beginning January 1, 2023, the Secretary may establish special enrollment periods in the case of individuals who satisfy paragraph (1) or (2) of section 1395o(a) of this title and meet such ex- ceptional conditions as the Secretary may pro- vide. (n) Enrollment for individuals only eligible for coverage of immunosuppressive drugs (1) Any individual who is eligible for coverage of immunosuppressive drugs under section 1395o(b) of this title may enroll or be deemed to have enrolled only in such manner and form as may be prescribed by regulations, and only dur- ing an enrollment period described in this sub- section. (2) An individual described in paragraph (1) whose entitlement for hospital insurance bene- fits under part A ends by reason of section 426–1(b)(2) of this title prior to January 1, 2023, may enroll beginning on October 1, 2022, or the day on which the individual first satisfies sec- tion 1395o(b) of this title, whichever is later. (3) An individual described in paragraph (1) whose entitlement for hospital insurance bene- fits under part A ends by reason of section 426–1(b)(2) of this title on or after January 1, 2023, shall be deemed to have enrolled in the medical insurance program established by this part for purposes of coverage of immuno- suppressive drugs. (4) The Secretary shall establish a process under which an individual described in para- graph (1) whose other coverage described in sec- tion 1395o(b)(2)(A) of this title, or coverage under this part (including the medical insurance program established under this part for purposes of coverage of immunosuppressive drugs), is ter- minated voluntarily or involuntary 1 may enroll or reenroll, if applicable, in the medical insur- ance program established under this part for purposes of coverage of immunosuppressive drugs. (o) Special enrollment period for certain Postal Service annuitants and family members (1) In the case of an individual who— (A) as of January 1, 2024, is— (i) a Postal Service annuitant who is enti- tled to benefits under part A of this sub- chapter, but excluding an individual who is eligible to enroll under such part under sec- tion 1395i–2 of this title or 1395i–2a of this title; or (ii) a member of family (as defined in sec- tion 8901(5) of title 5) of a Postal Service an- nuitant and is entitled to benefits under part A of this subchapter, but excluding an indi- vidual who is eligible to enroll under such part under section 1395i–2 of this title or 1395i–2a of this title; and (B) is not enrolled under this part, the indi- vidual may elect to be enrolled under this part during a special enrollment period during the 6-month period beginning on April 1, 2024. (2) In this subsection, the term ‘‘Postal Serv- ice annuitant’’ means an annuitant enrolled in a health benefits plan under chapter 89 of title 5, whose Government contribution is required to be paid under section 8906(g)(2) of such title. (Aug. 14, 1935, ch. 531, title XVIII, § 1837, as added Pub. L. 89–97, title I, § 102(a), July 30, 1965, 79 Stat. 304; amended Pub. L. 89–384, § 3(a), (b), Apr. 8, 1966, 80 Stat. 105; Pub. L. 90–248, title I, §§ 136(a), 145(a), (b), Jan. 2, 1968, 81 Stat. 853, 859; Pub. L. 92–603, title II, §§ 201(c)(2), 206(a), 259(a), 260, Oct. 30, 1972, 86 Stat. 1372, 1378, 1448; Pub. L. 96–265, title I, § 103(a)(3), June 9, 1980, 94 Stat. 444; Pub. L. 96–499, title IX, § 945(a), (b), Dec. 5, 1980, 94 Stat. 2642; Pub. L. 97–35, title XXI, § 2151(a)(1), (2), Aug. 13, 1981, 95 Stat. 801; Pub. L. 98–369, div. B, title III, §§ 2338(b), 2354(b)(10), July 18, 1984, 98 Stat. 1092, 1101; Pub. L. 99–272, title IX, §§ 9201(c)(1), 9219(a)(2), Apr. 7, 1986, 100 Stat. 171, Page 3175 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1395p 182; Pub. L. 99–509, title IX, § 9319(c)(1)–(3), Oct. 21, 1986, 100 Stat. 2011; Pub. L. 99–514, title XVIII, § 1895(b)(12), Oct. 22, 1986, 100 Stat. 2934; Pub. L. 101–239, title VI, § 6202(b)(4)(C), (c)(1), Dec. 19, 1989, 103 Stat. 2233; Pub. L. 103–432, title I, §§ 147(f)(1)(A), 151(c)(2), Oct. 31, 1994, 108 Stat. 4430, 4435; Pub. L. 105–33, title IV, §§ 4581(b)(1), 4631(a)(2), Aug. 5, 1997, 111 Stat. 465, 486; Pub. L. 106–554, § 1(a)(6) [title I, § 115(b)], Dec. 21, 2000, 114 Stat. 2763, 2763A–474; Pub. L. 109–171, title V, § 5115(a)(2)(A), Feb. 8, 2006, 120 Stat. 45; Pub. L. 111–148, title III, § 3110(a)(1), Mar. 23, 2010, 124 Stat. 420; Pub. L. 116–260, div. CC, title I, § 120(a)(2)(A), title IV, § 402(a)(2)(B), (b), Dec. 27, 2020, 134 Stat. 2954, 2999; Pub. L. 117–108, title I, § 101(b)(1), Apr. 6, 2022, 136 Stat. 1136.) Editorial Notes REFERENCES IN TEXT Section 501 of the Internal Revenue Code of 1986, re- ferred to in subsec. (k)(3)(A)(ii), is classified to section 501 of Title 26, Internal Revenue Code. AMENDMENTS 2022—Subsec. (o). Pub. L. 117–108 added subsec. (o). 2020—Pub. 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). Pub. L. 116–260, § 402(a)(2)(B)(ii), sub- stituted ‘‘section 1395o(a)(1) of this title’’ for ‘‘section 1395o(1) of this title’’. Subsec. (m). Pub. L. 116–260, § 120(a)(2)(A), added sub- sec. (m). Subsec. (n). Pub. L. 116–260, § 402(b), added subsec. (n). 2010—Subsec. (l). Pub. L. 111–148 added subsec. (l). 2006—Subsec. (k). Pub. L. 109–171 added subsec. (k). 2000—Subsec. (j). Pub. L. 106–554 added subsec. (j). 1997—Subsec. (i)(1) to (3). Pub. L. 105–33, § 4631(a)(2), substituted ‘‘1395y(b)(1)(B)(iii) of this title’’ for ‘‘1395y(b)(1)(B)(iv) of this title’’ wherever appearing. Subsec. (i)(4). Pub. L. 105–33, § 4581(b)(1), added par. (4). 1994—Subsec. (i)(1). Pub. L. 103–432, § 151(c)(2)(A), in closing provisions substituted ‘‘(as that term is defined in section 1395y(b)(1)(B)(iv) of this title) by reason of the individual’s current employment status (or the cur- rent employment status of a family member of the in- dividual)’’ for ‘‘as an active individual (as those terms are defined in section 1395y(b)(1)(B)(iv) of this title)’’. Subsec. (i)(1)(A). Pub. L. 103–432, § 151(c)(2)(D), in- serted ‘‘status’’ after ‘‘current employment’’. Subsec. (i)(2). Pub. L. 103–432, § 151(c)(2)(A), (C), in closing provisions substituted ‘‘(as that term is defined in section 1395y(b)(1)(B)(iv) of this title) by reason of the individual’s current employment status (or the cur- rent employment status of a family member of the in- dividual)’’ for ‘‘as an active individual (as those terms are defined in section 1395y(b)(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 indi- vidual’’. Subsec. (i)(2)(B), (C). Pub. L. 103–432, § 151(c)(2)(D), in- serted ‘‘status’’ after ‘‘current employment’’. Subsec. (i)(3)(A). Pub. L. 103–432, § 151(c)(2)(D), in- serted ‘‘status’’ after ‘‘current employment’’. Pub. 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 en- rolled’’ for ‘‘and ending seven months later’’. Subsec. (i)(3)(B). Pub. L. 103–432, § 151(c)(2)(B), sub- stituted ‘‘in a large group health plan (as that term is defined in section 1395y(b)(1)(B)(iv) of this title) by rea- son 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(b)(1)(B)(iv) of this title)’’. Pub. 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 en- rolled’’ for ‘‘and ending seven months later’’. 1989—Subsec. (i)(1). Pub. L. 101–239, § 6202(c)(1)(A), re- designated subpars. (B) and (C) as (A) and (B), respec- tively, struck out former subpar. (A) which read as fol- lows: ‘‘has attained the age of 65,’’, and inserted ‘‘not described in the previous sentence’’ after ‘‘In the case of an individual’’ in second sentence. Pub. L. 101–239, § 6202(b)(4)(C), substituted ‘‘section 1395y(b)(1)(A)(v)’’ and ‘‘section 1395y(b)(1)(B)(iv)’’ for ‘‘section 1395y(b)(3)(A)(iv)’’ and ‘‘section 1395y(b)(4)(B)’’, respectively. Subsec. (i)(2). Pub. L. 101–239, § 6202(c)(1)(B), sub- stituted ‘‘(1)(A)’’ for ‘‘(1)(B)’’ in subpar. (B)(i), redesig- nated 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 de- scribed in the previous sentence’’ after ‘‘In the case of an individual’’ in second sentence. Pub. L. 101–239, § 6202(b)(4)(C), substituted ‘‘section 1395y(b)(1)(A)(v)’’ and ‘‘section 1395y(b)(1)(B)(iv)’’ for ‘‘section 1395y(b)(3)(A)(iv)’’ and ‘‘section 1395y(b)(4)(B)’’, respectively. Subsec. (i)(3). Pub. L. 101–239, § 6202(b)(4)(C), sub- stituted ‘‘section 1395y(b)(1)(A)(v)’’ and ‘‘section 1395y(b)(1)(B)(iv)’’ for ‘‘section 1395y(b)(3)(A)(iv)’’ and ‘‘section 1395y(b)(4)(B)’’, respectively. 1986—Subsec. (i)(1). Pub. L. 99–509, § 9319(c)(1), inserted sentence at end providing for a special enrollment pe- riod described in paragraph (3)(B) for individuals not age 65, enrolled in a large health plan, and having elect- ed not to enroll during initial enrollment period. Subsec. (i)(1)(A). Pub. L. 99–514 realigned margins of subpar. (A). Pub. 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(b)(3)(A) of this title’’. Subsec. (i)(2). Pub. L. 99–509, § 9319(c)(2), inserted sen- tence 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 ter- minated enrollment. Subsec. (i)(2)(A). Pub. L. 99–272, § 9219(a)(2)(B), amend- ed subpar. (A) generally, substituting ‘‘has attained the age of 65;’’ for ‘‘meets the conditions described in clauses (i) and (iii) of section 1395y(b)(3)(A) of this title,’’. Subsec. (i)(2)(B). Pub. L. 99–272, § 9219(a)(2)(B), amend- ed 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 es- tablished under this part during the individual’s initial enrollment period and any subsequent special enroll- ment period under this subsection during which the in- dividual was not enrolled in a group health plan de- scribed in section 1395y(b)(3)(A)(iv) of this title by rea- son of the individual’s (or individual’s spouse’s) current employment, and’’. Subsec. (i)(2)(C), (D). Pub. L. 99–272, § 9219(a)(2)(B), added subpar. (C) and redesignated former subpar. (C) as (D). Subsec. (i)(3). Pub. 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). Page 3176 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1395p Pub. 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). Pub. L. 98–369, § 2354(b)(10), sub- stituted ‘‘section 426(b) 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). Pub. L. 98–369, § 2338(b), added subsec. (i). 1981—Subsec. (e). Pub. L. 97–35, § 2151(a)(1), sub- stituted ‘‘during the period beginning on January 1 and ending on March 31 of each year’’ for ‘‘which is any pe- riod after the period described in subsection (d) of this section’’. Subsec. (g)(3). Pub. L. 97–35, § 2151(a)(2), substituted ‘‘the earlier of the then current or immediately suc- ceeding general enrollment period (as defined in sub- section (e) of this section)’’ for ‘‘the month in which the individual files an application establishing such en- titlement’’. 1980—Subsec. (b). Pub. L. 96–499, § 945(a), struck out subsec. (b) which provided that no individual could en- roll under this part more than twice. Subsec. (e). Pub. L. 96–499, § 945(b)(1), substituted ‘‘which is any period after the period described in sub- section (d) of this section’’ for ‘‘, after the period de- scribed in subsection (c) of this section, during the pe- riod beginning on January 1 and ending on March 31 of each year beginning with 1969’’. Subsec. (g)(1). Pub. L. 96–265 substituted ‘‘the 25th month’’ for ‘‘the 25th consecutive month’’. Subsec. (g)(3). Pub. L. 96–499, § 945(b)(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 enroll- ment period (as defined in subsection (e) of this sec- tion)’’. 1972—Subsec. (b). Pub. L. 92–603, § 260, struck out pro- visions preventing enrollment under this part more than three years after first opportunity for such enroll- ment. Subsec. (c). Pub. L. 92–603, § 201(c)(2)(A), (B), sub- stituted ‘‘paragraph (1) or (2)’’ for ‘‘paragraphs (1) and (2)’’, and substituted provisions relating to the treat- ment 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 relat- ing to the treatment of an individual who satisfies paragraph (2) of section 1395o of this title solely by rea- son of subparagraph (B) thereof. Subsec. (d). Pub. L. 92–603, § 201(c)(2)(C), substituted ‘‘paragraph (1) or (2)’’ for ‘‘paragraphs (1) and (2)’’. Subsecs. (f), (g). Pub. L. 92–603, § 206(a), added subsecs. (f) and (g). Subsec. (h). Pub. L. 92–603, § 259(a), added subsec. (h). 1968—Subsec. (b)(1). Pub. L. 90–248, § 145(a), permitted an individual enrolling in supplementary medical in- surance 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). Pub. L. 90–248, § 136(a), inserted last sen- tence 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). Pub. L. 90–248, § 145(b), provided for an an- nual general enrollment period for supplementary med- ical insurance program beginning January 1 and ending March 31 of each year, commencing in 1969. 1966—Subsec. (c). Pub. L. 89–384, § 3(a), delayed eligi- bility 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). Pub. L. 89–384, § 3(b), substituted March 1, 1966, for January 1, 1966. Statutory Notes and Related Subsidiaries EFFECTIVE DATE OF 2010 AMENDMENT Pub. L. 111–148, title III, § 3110(a)(2), Mar. 23, 2010, 124 Stat. 420, as amended by Pub. L. 111–309, title II, § 201, Dec. 15, 2010, 124 Stat. 3289, provided that: ‘‘The amend- ment 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].’’ [Pub. 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 Pub. L. 111–148, set out above, is effective as if included in the enactment of Pub. L. 111–148.] EFFECTIVE DATE OF 2006 AMENDMENT Pub. L. 109–171, title V, § 5115(b), Feb. 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 amend- ments made by subsection (a)(2) [amending this section and section 1395q of this title] shall take effect on Jan- uary 1, 2007.’’ EFFECTIVE DATE OF 2000 AMENDMENT Amendment by Pub. L. 106–554 applicable to benefits for months beginning July 1, 2001, see section 1(a)(6) [title I, § 115(c)] of Pub. L. 106–554, set out as a note under section 426 of this title. EFFECTIVE DATE OF 1997 AMENDMENT Pub. L. 105–33, title IV, § 4581(c), Aug. 5, 1997, 111 Stat. 465, provided that: ‘‘The amendments made by this sec- tion [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 Pub. 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 en- actment of this Act [Oct. 31, 1994].’’ Pub. 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 Pub. L. 103–66. EFFECTIVE DATE OF 1989 AMENDMENT Amendment by section 6202(b)(4)(C) of Pub. L. 101–239 applicable to items and services furnished after Dec. 19, 1989, see section 6202(b)(5) of Pub. L. 101–239, set out as a note under section 162 of Title 26, Internal Revenue Code. Pub. 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 Pub. L. 99–514 effective, except as oth- erwise provided, as if included in enactment of the Con- solidated Omnibus Budget Reconciliation Act of 1985, Pub. L. 99–272, see section 1895(e) of Pub. L. 99–514, set out as a note under section 162 of Title 26, Internal Rev- enue Code. Amendment by Pub. L. 99–509 applicable to enroll- ments occurring on or after Jan. 1, 1987, see section 9319(f)(2) of Pub. L. 99–509, set out as a note under sec- tion 1395y of this title. Pub. L. 99–272, title IX, § 9201(d)(2), Apr. 7, 1986, 100 Stat. 171, provided that: ‘‘The amendments made by 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