42 U.S.C. § 1395q — Coverage period

(a) Commencement. The period when a person is entitled to benefits under this part, called the person’s “coverage period,” begins on the latest of: (1) July 1, 1966, or, for a disabled person under 65, July 1, 1973; (2) the applicable date for enrollment under section 1395p(d) or (e): (A) if the person enrolls under section 1395p(d) before the month when the person first meets paragraph (1) or (2) of section 1395o(a), the first day of that month; (B) if the person first meets that paragraph before January 2023 and enrolls under section 1395p(d): (i) in that same month, the first day of the month after enrollment; (ii) in the following month, the first day of the second month after enrollment; or (iii) more than one month later, the first day of the third month after enrollment; (C) if the person first meets that paragraph on or after January 1, 2023, and enrolls under section 1395p(d) in that month or a later initial-period month, the first day of the month after enrollment; or (D) if the person enrolls under section 1395p(e): (i) for a month before January 1, 2023, July 1 after the enrollment month; or (ii) for a month on or after that date, the first day after the enrollment month; and (3) for a person treated as enrolled: (A) if so treated on or before the last day of the third initial-period month, the first day of the month when the person first meets section 1395o(a), or July 1, 1973, whichever is later; or (B) if so treated on or after the first day of the fourth initial-period month, the date under paragraph (2)(B)(i), (ii), (iii), or (D)(i) for a month before January 1, 2023, or under (C) or (D)(ii) for a later month. (b) Continuation. Coverage continues until enrollment ends because: (1) the person files notice of no longer wishing to participate; or (2) premiums are not paid. Ending under (1) normally takes effect at the close of the month after the notice month, except as section 1395v(e) provides. Ending for nonpayment takes effect on a regulatory date. Regulations may allow a grace period for overdue premiums, not exceeding 90 days, or 180 days if the Secretary finds good cause. If a person treated as enrolled under section 1395p(f) or (n)(3) files notice before the coverage month saying the person does not want enrollment, termination takes effect on the first day coverage would have started. If the person files notice in or after that month asking to end deemed coverage, termination takes effect at the close of the month after the notice month. (c) Termination. For a person meeting section 1395o(a)(1) whose part A entitlement is based on disability rather than age 65, coverage and enrollment under this part end at the close of the last month of part A entitlement. (d) Payment of expenses incurred during coverage period. This part may not pay expenses unless the person incurred them during that person’s coverage period. (e) Commencement of coverage for special enrollment periods. Despite (a), for a person enrolling under section 1395p(i)(3) or (i)(4)(B): (1) if enrollment is in a special-period month when the person is at any time enrolled in the plan specified in section 1395p(i)(3)(A) or (B), as applicable, or section 1395p(i)(4)(A)(i), or in the first month afterward, coverage starts the first day of the enrollment month, or at the person’s option the first day of any of the next three months; (2) in any other special-period month, coverage starts the first day after the enrollment month. (f) Commencement of coverage for certain volunteers serving outside United States. Despite (a), for a person enrolling under section 1395p(k), coverage starts the first day after the enrollment month. (g) Special enrollment periods for exceptional circumstances. Despite (a), for a person enrolling under section 1395p(m), coverage starts on the date the Secretary provides in a way consistent, as far as practicable, with protecting continuous health-benefit coverage. (h) Coverage period for individuals only eligible for coverage of immunosuppressive drugs. For a person described in section 1395o(b)(1): (1) if automatically enrolled in part B under section 1395p(n)(3), coverage starts the first day of the month when the person first meets section 1395o(b); (2) if enrolling or reenrolling under section 1395p(n)(2) or (4), coverage starts January 1, 2023, or the month after enrollment or reenrollment, whichever is later; (3) subsections (b) and (d) apply; (4) in addition to (b), coverage ends when the person becomes entitled under section 426(a) or (b), section 426–1, or is no longer eligible because of section 1395o(b)(2); and (5) the Secretary may conduct public education about the availability of more comprehensive individual health insurance coverage, as defined in section 300gg–91, for eligible people. (i) Coverage period for certain Postal Service annuitants and family members. Despite (a), for a person enrolling under section 1395p(o), coverage starts January 1, 2025.