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42 U.S.C. § 1395i–2aHospital insurance benefits for disabled individuals who have exhausted other entitlement

submitted 91 years ago by Pub. L. 101-239 to r/title-42-THE-PUBLIC-HEALTH-AND-WELFARE · 867 words · no verdicts yet

in plain englishAI-generated · not legal advice

This section allows certain people under age 65 whose disability-based Part A entitlement ended because their earnings exceeded the substantial-gainful-activity amount to enroll in Part A. It sets enrollment and coverage dates, termination rules, premiums, and limited application of the uninsured-elderly premium rules.

(a) Eligibility. A person may enroll if the person: (1) is under 65; (2) was entitled to Part A under section 426(b), still has the disabling physical or mental impairment that supported the disability finding or disabled railroad-beneficiary finding, or is blind within section 416(i)(1), and lost that entitlement only because earnings exceeded the "substantial gainful activity amount" in section 423(d)(4); and (3) is not otherwise entitled to Part A. This section does not define "substantial gainful activity amount." (b) Enrollment. (1) Enrollment must use the manner and form set by regulation and occur during an authorized enrollment period. (2) The initial enrollment period starts in the month the person receives notice that section 426(b) entitlement will end solely because earnings exceed that amount, and ends 7 months later. (3) Beginning in 1990, a general enrollment period runs from January 1 through March 31 each year. (c) Coverage period. (1) Coverage starts on the latest applicable date: (A) for enrollment before the first month the person meets subsection (a), the first day of that month; (B) for enrollment in that first eligible month, the first day of the following month; (C) for enrollment in the next month, the first day of the second following month; (D) for enrollment more than one month later, the first day of the third month after enrollment; or (E) for general-period enrollment, the July 1 after enrollment. (2) Coverage continues until: (A) the month after the Secretary tells the person the person no longer meets subsection (a)(2)(B); (B) the month after the person gives notice of withdrawal; (C) the month before the first month the person becomes eligible under section 426(a) or 426–1; or (D) a regulatory date for unpaid premiums. A regulation may allow a grace period of up to 90 days, extended to at most 180 days for good cause. Ending this coverage also ends coverage affected under any other part of this subchapter. (3) Section 1395p(h), (i), and (m) applies to enrollment and nonenrollment here as it applies to enrollment, nonenrollment, and special periods under section 1395i–2. (d) Payment of premiums. (1)(A) Premiums must be paid to the Secretary at the times and in the manner set by regulation and deposited into the Treasury for the Hospital Insurance Trust Fund. (B) Premiums are due from the first month of coverage through the month the person dies or coverage ends, whichever comes first, but not for a month in which the person is eligible under section 426(b). (2) The premium provisions in section 1395i–2(d) through (f) apply to people enrolled under this section in the same way they apply to people enrolled under that section.
the actual law source: uscode.house.gov ↗public domain
(a) Eligibility

Every individual who—

(1)

has not attained the age of 65;

(2)
(A)

has been entitled to benefits under this part under section 426(b) of this title, and

(B)
(i)

continues to have the disabling physical or mental impairment on the basis of which the individual was found to be under a disability or to be a disabled qualified railroad retirement beneficiary, or (ii) is blind (within the meaning of section 416(i)(1) of this title), but

(C)

whose entitlement under section 426(b) of this title ends due solely to the individual having earnings that exceed the substantial gainful activity amount (as defined in section 423(d)(4) of this title); and

(3)

is not otherwise entitled to benefits under this part,

shall be eligible to enroll in the insurance program established by this part.

(b) Enrollment
(1)

An individual may enroll under this section only in such manner and form as may be prescribed in regulations, and only during an enrollment period prescribed in or under this section.

(2)

The individual’s initial enrollment period shall begin with the month in which the individual receives notice that the individual’s entitlement to benefits under section 426(b) of this title will end due solely to the individual having earnings that exceed the substantial gainful activity amount (as defined in section 423(d)(4) of this title and shall end 7 months later.

(3)

There shall be a general enrollment period during the period beginning on January 1 and ending on March 31 of each year (beginning with 1990).

(c) Coverage period
(1)

The period (in this subsection referred to as a “coverage period”) during which an individual is entitled to benefits under the insurance program under this part shall begin on whichever of the following is the latest:

(A)

In the case of an individual who enrolls under subsection (b)(2) before the month in which the individual first satisfies subsection (a), the first day of such month.

(B)

In the case of an individual who enrolls under subsection (b)(2) in the month in which the individual first satisfies subsection (a), the first day of the month following the month in which the individual so enrolls.

(C)

In the case of an individual who enrolls under subsection (b)(2) in the month following the month in which the individual first satisfies subsection (a), the first day of the second month following the month in which the individual so enrolls.

(D)

In the case of an individual who enrolls under subsection (b)(2) more than one month following the month in which the individual first satisfies subsection (a), the first day of the third month following the month in which the individual so enrolls.

(E)

In the case of an individual who enrolls under subsection (b)(3), the July 1 following the month in which the individual so enrolls.

(2)

An individual’s coverage period under this section shall continue until the individual’s enrollment is terminated as follows:

(A)

As of the month following the month in which the Secretary provides notice to the individual that the individual no longer meets the condition described in subsection (a)(2)(B).

(B)

As of the month following the month in which the individual files notice that the individual no longer wishes to participate in the insurance program established by this part.

(C)

As of the month before the first month in which the individual becomes eligible for hospital insurance benefits under section 426(a) or 426–1 of this title.

(D)

As of a date, determined under regulations of the Secretary, for nonpayment of premiums.

The regulations under subparagraph (D) may provide a grace period of not longer than 90 days, which may be extended to not to exceed 180 days in any case where the Secretary determines that there was good cause for failure to pay the overdue premiums within such 90-day period. Termination of coverage under this section shall result in simultaneous termination of any coverage affected under any other part of this subchapter.

(3)

The provisions of subsections (h), (i), and (m) of section 1395p of this title apply to enrollment and nonenrollment under this section in the same manner as they apply to enrollment and nonenrollment and special enrollment periods under section 1395i–2 of this title.

(d) Payment of premiums
(1)
(A)

Premiums for enrollment under this section shall be paid to the Secretary at such times, and in such manner, as the Secretary shall by regulations prescribe, and shall be deposited in the Treasury to the credit of the Federal Hospital Insurance Trust Fund.

(B)
(i)

Subject to clause (ii), such premiums shall be payable for the period commencing with the first month of an individual’s coverage period and ending with the month in which the individual dies or, if earlier, in which the individual’s coverage period terminates.

(ii)

Such premiums shall not be payable for any month in which the individual is eligible for benefits under this part pursuant to section 426(b) of this title.

(2)

The provisions of subsections (d) through (f) of section 1395i–2 of this title (relating to premiums) shall apply to individuals enrolled under this section in the same manner as they apply to individuals enrolled under that section.

Source credit: (Aug. 14, 1935, ch. 531, title XVIII, § 1818A, as added Pub. L. 101–239, title VI, § 6012(a)(2), Dec. 19, 1989, 103 Stat. 2161; amended Pub. L. 101–508, title IV, § 4008(m)(3)(C), Nov. 5, 1990, 104 Stat. 1388–54; Pub. L. 116–260, div. CC, title I, § 120(a)(2)(C)(i), Dec. 27, 2020, 134 Stat. 2954.)

history & why it existsrecord from the source credit
  • 1935Enacted · Pub. L. 101-239 · 103 Stat. 2161
  • 1990Amended · Pub. L. 101-508 · 104 Stat. 1388
  • 2020Amended · Pub. L. 116-260 · 134 Stat. 2954

A history note hasn’t been published yet. The record shows enactment by Pub. L. 101-239 on 1935-08-14.

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