42 U.S.C. § 1395s — Payment of premiums
submitted 91 years ago by Pub. L. 89-97 to r/title-42-THE-PUBLIC-HEALTH-AND-WELFARE · 1,191 words · no verdicts yet
This section explains how Part B premiums are collected from Social Security, railroad-retirement, civil-service, or other payments. It also covers direct payments, the premium period, exemptions, and Medicare+Choice adjustments.
(a) Social Security deductions. (1) For a person* entitled to section 402 or 423 monthly benefits, premiums must normally be deducted from those benefits, except under (b)(1) and (c), at the Commissioner’s regulated times and method after consultation with the Secretary*. (2) Treasury must transfer the total deductions from the applicable Social Security trust fund to the Federal Supplementary Medical Insurance Trust Fund, based on the Commissioner’s certification and adjusted for earlier over- or under-transfers.
(b) Railroad deductions. (1) For a person receiving a Railroad Retirement Act of 1974 annuity for a month, premiums must normally be deducted from that annuity or pension, whether or not the person also receives section 402 benefits, except under (c). The Secretary regulates timing and method after consulting the Railroad Retirement Board. (2) Treasury must transfer the deductions from the Railroad Retirement Account to the Supplementary Medical Insurance Trust Fund, based on Board certification and adjusted for earlier errors.
(c) If a person covered by (a) or (b) expects the available deduction for a premium period to be less than the premiums, the person may, under regulations*, pay the Secretary any desired part of the premiums.
(d) Civil-service annuities. (1) For a person receiving a qualifying civil-service or other Office of Personnel Management retirement or survivor annuity to whom (a) and (b) do not apply, premiums must be deducted from each installment after notice from Health and Human Services to the Office Director*. With the person’s agreement, the spouse’s premiums are also deducted if neither (a) nor (b) applies to the spouse. The Director sets timing and method and must provide reasonably requested information. A section 8903 or 8903a plan may reimburse an enrolled annuitant’s premiums if paid entirely from plan funds other than section 8906 contributions. (2) At least quarterly, Treasury must transfer the deductions from the Civil Service Retirement and Disability Fund or applicable account to the Supplementary Medical Insurance Trust Fund, based on the Director’s certification and adjusted for earlier errors.
(e) If none of the earlier rules applies, or (c) applies, the person pays premiums to the Secretary at regulated times and in the regulated manner.
(f) Amounts paid under (c) or (e) must be deposited in the Treasury for the Supplementary Medical Insurance Trust Fund.
(g) Premiums are payable from the first month of coverage through the month of death, or the earlier month when coverage ends.
(h) For a person enrolled through a State* agreement under section 1395v, (a)–(d) do not apply to a coverage-period month whose premium is determined under section 1395v(d).
(i) For a Medicare+Choice enrollee, the Secretary must adjust the monthly premium to reflect 80 percent of a section 1395w–24(f)(1)(E) reduction and any section 1395w–24(b)(1)(C)(iv) credit. With the responsible agency’s agreement, the adjustment may be made directly to Social Security, railroad-retirement, or civil-service-retirement benefits. For a person receiving subchapter XIX assistance for the costs in section 1396d(p)(3)(A)(ii), it may instead adjust what the State otherwise owes for that assistance.
In the case of an individual who is entitled to monthly benefits under section 402 or 423 of this title, his monthly premiums under this part shall (except as provided in subsections (b)(1) and (c)) be collected by deducting the amount thereof from the amount of such monthly benefits. Such deduction shall be made in such manner and at such times as the Commissioner of Social Security shall by regulation prescribe. Such regulations* shall be prescribed after consultation with the Secretary*.
The Secretary of the Treasury shall, from time to time, transfer from the Federal Old-Age and Survivors Insurance Trust Fund or the Federal Disability Insurance Trust Fund to the Federal Supplementary Medical Insurance Trust Fund the aggregate amount deducted under paragraph (1) for the period to which such transfer relates from benefits under section 402 or 423 of this title which are payable from such Trust Fund. Such transfer shall be made on the basis of a certification by the Commissioner of Social Security and shall be appropriately adjusted to the extent that prior transfers were too great or too small.
In the case of an individual who is entitled to receive for a month an annuity under the Railroad Retirement Act of 1974 [45 U.S.C. 231 et seq.] (whether or not such individual is also entitled for such month to a monthly insurance benefit under section 402 of this title), his monthly premiums under this part shall (except as provided in subsection (c)) be collected by deducting the amount thereof from such annuity or pension. Such deduction shall be made in such manner and at such times as the Secretary shall by regulations prescribe. Such regulations shall be prescribed only after consultation with the Railroad Retirement Board.
The Secretary of the Treasury shall, from time to time, transfer from the Railroad Retirement Account to the Federal Supplementary Medical Insurance Trust Fund the aggregate amount deducted under paragraph (1) for the period to which such transfer relates. Such transfers shall be made on the basis of a certification by the Railroad Retirement Board and shall be appropriately adjusted to the extent that prior transfers were too great or too small.
If an individual to whom subsection (a) or (b) applies estimates that the amount which will be available for deduction under such subsection for any premium payment period will be less than the amount of the monthly premiums for such period, he may (under regulations) pay to the Secretary such portion of the monthly premiums for such period as he desires.
In the case of an individual receiving an annuity under subchapter III of chapter 83 of title 5 or any other law administered by the Director* of the Office of Personnel Management providing retirement or survivorship protection, to whom neither subsection (a) nor subsection (b) applies, his monthly premiums under this part (and the monthly premiums of the spouse of such individual under this part if neither subsection (a) nor subsection (b) applies to such spouse and if such individual agrees) shall, upon notice from the Secretary of Health and Human Services to the Director of the Office of Personnel Management, be collected by deducting the amount thereof from each installment of such annuity. Such deduction shall be made in such manner and at such times as the Director of the Office of Personnel Management may determine. The Director of the Office of Personnel Management shall furnish such information as the Secretary of Health and Human Services may reasonably request in order to carry out his functions under this part with respect to individuals to whom this subsection applies. A plan described in section 8903 or 8903a of title 5 may reimburse each annuitant enrolled in such plan an amount equal to the premiums paid by him under this part if such reimbursement is paid entirely from funds of such plan which are derived from sources other than the contributions described in section 8906 of such title.
The Secretary of the Treasury shall, from time to time, but not less often than quarterly, transfer from the Civil Service Retirement and Disability Fund, or the account (if any) applicable in the case of such other law administered by the Director of the Office of Personnel Management, to the Federal Supplementary Medical Insurance Trust Fund the aggregate amount deducted under paragraph (1) for the period to which such transfer relates. Such transfer shall be made on the basis of a certification by the Director of the Office of Personnel Management and shall be appropriately adjusted to the extent that prior transfers were too great or too small.
In the case of an individual who participates in the insurance program established by this part but with respect to whom none of the preceding provisions of this section applies, or with respect to whom subsection (c) applies, the premiums shall be paid to the Secretary at such times, and in such manner, as the Secretary shall by regulations prescribe.
Amounts paid to the Secretary under subsection (c) or (e) shall be deposited in the Treasury to the credit of the Federal Supplementary Medical Insurance Trust Fund.
In the case of an individual who participates in the insurance program established by this part, premiums shall be payable for the period commencing with the first month of his coverage period and ending with the month in which he dies or, if earlier, in which his coverage under such program terminates.
In the case of an individual who is enrolled under the program established by this part as a member of a coverage group to which an agreement with a State* entered into pursuant to section 1395v of this title is applicable, subsections (a), (b), (c), and (d) of this section shall not apply to his monthly premium for any month in his coverage period which is determined under section 1395v(d) of this title.
In the case of an individual enrolled in a Medicare+Choice plan, the Secretary shall provide for necessary adjustments of the monthly beneficiary premium to reflect 80 percent of any reduction elected under section 1395w–24(f)(1)(E) of this title and to reflect any credit provided under section 1395w–24(b)(1)(C)(iv) 1 of this title. To the extent to which the Secretary determines that such an adjustment is appropriate, with the concurrence of any agency responsible for the administration* of such benefits, such premium adjustment may be provided directly, as an adjustment to any social security, railroad retirement, or civil service retirement benefits, or, in the case of an individual who receives medical assistance under subchapter XIX for medicare costs described in section 1396d(p)(3)(A)(ii) of this title, as an adjustment to the amount otherwise owed by the State for such medical assistance.
Source credit: (Aug. 14, 1935, ch. 531, title XVIII, § 1840, as added Pub. L. 89–97, title I, § 102(a), July 30, 1965, 79 Stat. 306; amended Pub. L. 89–384, § 4(c), Apr. 8, 1966, 80 Stat. 106; Pub. L. 90–248, title I, § 166, title IV, § 403(g), Jan. 2, 1968, 81 Stat. 874, 932; Pub. L. 92–603, title II, §§ 201(c)(6), 263(a)–(d)(3), Oct. 30, 1972, 86 Stat. 1373, 1448, 1449; Pub. L. 93–445, title III, § 306, Oct. 16, 1974, 88 Stat. 1358; Pub. L. 98–369, div. B, title III, § 2354(b)(11), title VI, § 2663(j)(2)(F)(ii), July 18, 1984, 98 Stat. 1101, 1170; Pub. L. 99–53, § 2(g), June 17, 1985, 99 Stat. 94; Pub. L. 100–360, title II, § 212(b)(1), July 1, 1988, 102 Stat. 740; Pub. L. 100–485, title VI, § 608(d)(10)(B), Oct. 13, 1988, 102 Stat. 2415; Pub. L. 101–234, title II, § 202(a), Dec. 13, 1989, 103 Stat. 1981; Pub. L. 103–296, title I, § 108(c)(2), Aug. 15, 1994, 108 Stat. 1485; Pub. L. 106–554, § 1(a)(6) [title VI, § 606(a)(2)(B)(ii)], Dec. 21, 2000, 114 Stat. 2763, 2763A–557; Pub. L. 108–173, title II, § 222(l)(2)(B), Dec. 8, 2003, 117 Stat. 2206.)
- 1935Enacted · Pub. L. 89-97 · 79 Stat. 306
- 1966Amended · Pub. L. 89-384 · 80 Stat. 106
- 1968Amended · Pub. L. 90-248 · 81 Stat. 874, 932
- 1972Amended · Pub. L. 92-603 · 86 Stat. 1373, 1448, 1449
- 1974Amended · Pub. L. 93-445 · 88 Stat. 1358
- 1984Amended · Pub. L. 98-369 · 98 Stat. 1101, 1170
- 1985Amended · Pub. L. 99-53 · 99 Stat. 94
- 1988Amended · Pub. L. 100-360 · 102 Stat. 740
- 1988Amended · Pub. L. 100-485 · 102 Stat. 2415
- 1989Amended · Pub. L. 101-234 · 103 Stat. 1981
- 1994Amended · Pub. L. 103-296 · 108 Stat. 1485
- 2000Amended · Pub. L. 106-554 · 114 Stat. 2763, 2763
- 2003Amended · Pub. L. 108-173 · 117 Stat. 2206
A history note hasn’t been published yet. The record shows enactment by Pub. L. 89-97 on 1935-08-14.
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