42 U.S.C. § 1395i–2 — Hospital insurance benefits for uninsured elderly individuals not otherwise eligible

(a) Individuals eligible to enroll. A person^* may enroll if the person: (1) is at least 65; (2) is enrolled in Part B; (3) lives in the United States^* and is either a citizen or a lawful permanent resident who lived continuously in the United States for the 5 years before applying; and (4) is not otherwise entitled to Part A benefits. Unless another rule says otherwise, a reference to someone entitled to Part A also includes someone entitled through enrollment under this section or section 1395i–2a.

(b) Time, manner, and form of enrollment. A person may enroll only in the manner and form set by regulation and only during an enrollment period provided by or under this section.

(c) Period of enrollment; scope of coverage. The rules in section 1395p, except subsections (f) and (o), section 1395q, section 1395r(b), and section 1395s(f) and (h) apply to people authorized to enroll here, with these changes: (1) People meeting the age, residence/citizenship, and non-entitlement conditions by the last day of the seventh month after October 1972 could enroll in Part A, and also Part B if not already enrolled, during an initial general period beginning on the first day of the second month after October 30, 1972, and ending on the last day of the tenth month after October 1972. (2) For someone first eligible on or after the first day of the eighth month after October 1972, the initial period begins on the first day of the third month before first eligibility and ends 7 months later. (3) For someone enrolling under paragraph (1), Part A entitlement begins on the latest of: (A) the first day of the second month after enrollment; (B) July 1, 1973; or (C) the first day of the first month the person meets subsection (a). (4) Enrollment ends with the month before the first month the person becomes eligible for Part A under section 426 or 426a. At that point, solely for Part A entitlement, the person is treated as having filed the required application in that first eligible month. (5) Ending supplementary medical insurance coverage also ends Part A coverage for an uninsured person who is not otherwise entitled. (6) Any percentage increase in the monthly premium under section 1395r(b) cannot exceed 10 percent, applies only for a period twice as long as the number of full 12-month periods described there, and is subject to subsection (d)(6). (7) A person meeting subsection (a) may enroll during a special period that includes any month in which the person is enrolled with an eligible organization under section 1395mm, and ends on the last day of the eighth consecutive month in which the person is never so enrolled. (8) If the person enrolls during that special period, coverage begins on the first day of the enrollment month, or at the person's option one of the next 3 months, when the person is enrolled with the organization in that month or in the first following month; otherwise it begins on the first day of the month after enrollment. (9) For applying section 1395r(b), do not count months for which the person proves enrollment with such an organization.

(d) Monthly premiums. (1) Each September beginning in 1988, the Secretary^* must estimate the next year's monthly actuarial rate. It is one-twelfth of the estimated average per-person amount equal to 100 percent of benefits and administrative costs payable from the Hospital Insurance Trust Fund for next year for people age 65 or older entitled under Part A. (2) Each September the Secretary must set and publish the dollar premium for the next year. Subject to paragraphs (4) and (5), it equals that actuarial rate. A non-dollar multiple is rounded to the nearest dollar, except a 50-cent multiple rounds up. (3) When publishing the premium, the Secretary must publicly state^* the actuarial assumptions and bases used. (4)(A) For a person described in (B), reduce the monthly premium by 25 percent for 1994, 30 percent for 1995, 35 percent for 1996, 40 percent for 1997, and 45 percent for 1998 and later. (B) A person qualifies for a month if, at the prior month's end, the person: (i) had at least 30 quarters of coverage under subchapter II; (ii) was married, and had been married for the prior year, to someone with at least 30 quarters; (iii) had been married for at least 1 year when a spouse with at least 30 quarters died; or (iv) is divorced after at least 10 years of marriage to someone who had at least 30 quarters at divorce.

(5)(A) The premium is zero for a person described in (B) if no State, political subdivision, or State agency or instrumentality pays any part of that premium and the person's premium was not so paid in each of the preceding 84 months of enrollment under this section. (B) A person qualifies if, at the prior month's end: (i) the person received cash benefits from a qualified State or local government retirement system because of covered employment and would have at least 40 quarters of coverage if Medicare-qualified government employment were treated as wages; (ii) the person was married for the prior year to someone described in clause (i), or met the quarters condition and was married to someone receiving the retirement benefits; (iii) the person had been married at least 1 year when a spouse meeting the relevant conditions died; or (iv) the person is divorced after at least 10 years from someone meeting the relevant conditions at divorce. (C) A "qualified State or local government retirement system" is one established or maintained by a State, political subdivision, or their agency or instrumentality; covering some or all employees of that government body; and not adjusting cash retirement benefits based on eligibility for this premium reduction.

(6)(A) If a State, subdivision, or agency or instrumentality agrees to pay for life the paragraph (1) premiums for every eligible person in a qualified retiree group, reduce any otherwise applicable section 1395r(b) increase, as modified by subsection (c)(6), by the total Internal Revenue Code section 3101(b) and 3111(b) taxes paid for that person on Medicare employment. (B) A qualified retiree group consists of people who retire before a specified date before January 1, 2002, from one or more occupations or broad employee classes of the State, its subdivision, or its agency or instrumentality.

(e) Contract or other arrangement for payment. A public or private agency or organization may pay premiums for an eligible person under an agreement with the Secretary if the Secretary finds the arrangement administratively feasible.

(f) Deposit of amounts into Treasury. Premiums paid to the Secretary under this section go into the Treasury credited to the Federal Hospital Insurance Trust Fund.

(g) Buy-in for qualified Medicare beneficiaries. (1) At a State's request after 1989, the Secretary must modify the State's section 1395v(a) agreement to enroll qualified Medicare beneficiaries in Part A. (2)(A) Sections 1395v(c), (d), (e), and (f) apply to those Part A enrollees as they apply to their Part B enrollment under the agreement. (B) For this subsection, apply section 1395v(d)(1) by replacing its reference to section 1395r with section 1395i–2 and replacing its reference to section 1395r(b) with subsection (c)(6), referring to section 1395r(b). This section does not define "eligible organization," "qualified Medicare beneficiary," or "qualified State or local government retiree group."