
From the U.S. Code Online via GPO Access
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[Laws in effect as of January 23, 2000]
[Document not affected by Public Laws enacted between
  January 23, 2000 and December 4, 2001]
[CITE: 42USC1395q]

 
                 TITLE 42--THE PUBLIC HEALTH AND WELFARE
 
                       CHAPTER 7--SOCIAL SECURITY
 
        SUBCHAPTER XVIII--HEALTH INSURANCE FOR AGED AND DISABLED
 
 Part B--Supplementary Medical Insurance Benefits for Aged and Disabled
 
Sec. 1395q. Coverage period


(a) Commencement

    The period during which an individual is entitled to benefits under 
the insurance program established 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 enrolls pursuant to 
    subsection (d) of section 1395p of this title before the month in 
    which he first satisfies paragraph (1) or (2) of section 1395o of 
    this title, the first day of such month, or
        (B) in the case of an individual who enrolls pursuant to such 
    subsection (d) in the month in which he first satisfies such 
    paragraph, the first day of the month following the month in which 
    he so enrolls, or
        (C) in the case of an individual who enrolls pursuant to such 
    subsection (d) in the month following the month in which he first 
    satisfies such paragraph, the first day of the second month 
    following the month in which he so enrolls, or
        (D) in the case of an individual who enrolls pursuant to such 
    subsection (d) more than one month following the month in which he 
    satisfies such paragraph, the first day of the third month following 
    the month in which he so enrolls, or
        (E) in the case of an individual who enrolls pursuant to 
    subsection (e) of section 1395p of this title, the July 1 following 
    the month in which he so enrolls; or
        (3)(A) in the case of an individual who is deemed to have 
    enrolled on or before the last day of the third month of his initial 
    enrollment period, the first day of the month in which he first 
    meets the applicable requirements of section 1395o of this title or 
    July 1, 1973, whichever is later, or
        (B) in the case of an individual who is deemed to have enrolled 
    on or after the first day of the fourth month of his initial 
    enrollment period, as prescribed under subparagraphs (B), (C), (D), 
    and (E) of paragraph (2) of this subsection.

(b) Continuation

    An individual's coverage period shall continue until his enrollment 
has been terminated--
        (1) by the filing of notice that the individual no longer wishes 
    to participate in the insurance program established by this part, or
        (2) for nonpayment of premiums.

The termination of a coverage period under paragraph (1) shall (except 
as otherwise provided in section 1395v(e) of this title) take effect at 
the close of the month following the month in which the notice is filed. 
The termination of a coverage period under paragraph (2) shall take 
effect on a date determined under regulations, which may be determined 
so as to provide a grace period in which overdue premiums may be paid 
and coverage continued. The grace period determined under the preceding 
sentence shall not exceed 90 days; except that it 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.
    Where an individual who is deemed to have enrolled for medical 
insurance pursuant to section 1395p(f) of this title files a notice 
before the first day of the month in which his coverage period begins 
advising that he does not wish to be so enrolled, the termination of the 
coverage period resulting from such deemed enrollment shall take effect 
with the first day of the month the coverage would have been effective. 
Where an individual who is deemed enrolled for medical insurance 
benefits pursuant to section 1395p(f) of this title files a notice 
requesting termination of his deemed coverage in or after the month in 
which such coverage becomes effective, the termination of such coverage 
shall take effect at the close of the month following the month in which 
the notice is filed.

(c) Termination

    In the case of an individual satisfying paragraph (1) of section 
1395o of this title whose entitlement to hospital insurance benefits 
under part A of this subchapter is based on a disability rather than on 
his having attained the age of 65, his coverage period (and his 
enrollment under this part) shall be terminated as of the close of the 
last month for which he is entitled to hospital insurance benefits.

(d) Payment of expenses incurred during coverage period

    No payments may be made under this part with respect to the expenses 
of an individual unless such expenses were incurred by such individual 
during a period which, with respect to him, is a coverage period.

(e) Commencement of coverage for special enrollment periods

    Notwithstanding subsection (a) of this section, in the case of an 
individual who enrolls during a special enrollment period pursuant to 
section 1395p(i)(3) or 1395p(i)(4)(B) of this title--
        (1) in any month of the special enrollment period in which the 
    individual is at any time enrolled in a plan (specified in 
    subparagraph (A) or (B), as applicable, of section 1395p(i)(3) of 
    this title or specified in section 1395p(i)(4)(A)(i) of this title) 
    or in the first month following such a month, the coverage period 
    shall begin on the first day of the month in which the individual so 
    enrolls (or, at the option of the individual, on the first day of 
    any of the following three months), or
        (2) in any other month of the special enrollment period, the 
    coverage period shall begin on the first day of the month following 
    the month in which the individual so enrolls.

(Aug. 14, 1935, ch. 531, title XVIII, Sec. 1838, as added Pub. L. 89-97, 
title I, Sec. 102(a), July 30, 1965, 79 Stat. 305; amended Pub. L. 90-
248, title I, Sec. 145(c), Jan. 2, 1968, 81 Stat. 859; Pub. L. 92-603, 
title II, Secs. 201(c)(3), 206(b), (c), 257(a), Oct. 30, 1972, 86 Stat. 
1373, 1378, 1447; Pub. L. 96-499, title IX, Secs. 945(c)(1), 947(b), 
Dec. 5, 1980, 94 Stat. 2642, 2643; Pub. L. 97-35, title XXI, 
Secs. 2106(b)(2), 2151(a)(3), Aug. 13, 1981, 95 Stat. 792, 802; Pub. L. 
98-369, div. B, title III, Sec. 2338(c), July 18, 1984, 98 Stat. 1092; 
Pub. L. 99-272, title IX, Sec. 9201(c)(2), Apr. 7, 1986, 100 Stat. 171; 
Pub. L. 99-509, title IX, Sec. 9344(b)(1), Oct. 21, 1986, 100 Stat. 
2042; Pub. L. 103-432, title I, Sec. 147(f)(1)(B), Oct. 31, 1994, 108 
Stat. 4430; Pub. L. 105-33, title IV, Sec. 4581(b)(2), Aug. 5, 1997, 111 
Stat. 465.)

                       References in Text

    Part A of this subchapter, referred to in subsec. (c), is classified 
to section 1395c et seq. of this title.


                               Amendments

    1997--Subsec. (e). Pub. L. 105-33 inserted ``or 1395p(i)(4)(B)'' 
after ``1395p(i)(3)'' in introductory provisions and ``or specified in 
section 1395p(i)(4)(A)(i) of this title'' after ``1395p(i)(3) of this 
title'' in par. (1).
    1994--Subsec. (e). Pub. L. 103-432 amended pars. (1) and (2) 
generally. Prior to amendment, pars. (1) and (2) read as follows:
    ``(1) in the first month of the special enrollment period, the 
coverage period shall begin on the first day of that month, or
    ``(2) in a month after the first month of the special enrollment 
period, the coverage period shall begin on the first day of the month 
following the month in which the individual so enrolls.''
    1986--Subsec. (b). Pub. L. 99-509 substituted ``month following the 
month'' for ``calendar quarter following the calendar quarter'' in 
second and sixth sentences.
    Subsec. (e). Pub. L. 99-272 amended subsec. (e) generally. Prior to 
amendment, subsec. (e) read as follows: ``Notwithstanding subsection (a) 
of this section, in the case of an individual who enrolls during a 
special enrollment period pursuant to--
        ``(1) subparagraph (A) of section 1395p(i)(3) of this title--
            ``(A) before the month in which he attains the age of 70, 
        the coverage period shall begin on the first day of the month in 
        which he has attained the age of 70, or
            ``(B) in or after the month in which he attains the age of 
        70, the coverage period shall begin on the first day of the 
        month following the month in which he so enrolls; or
        ``(2) subparagraph (B) of section 1395p(i)(3) of this title--
            ``(A) in the first month of the special enrollment period, 
        the coverage period shall begin on the first day of such month, 
        or
            ``(B) in a month after the first month of the special 
        enrollment period, the coverage period shall begin on the first 
        day of the month following the month in which he so enrolls.''
    1984--Subsec. (e). Pub. L. 98-369, Sec. 2338(c), added subsec. (e).
    1981--Subsec. (a)(2)(E). Pub. L. 97-35, Sec. 2151(a)(3), substituted 
``the July 1 following'' for ``the first day of the third month 
following''.
    Subsec. (b). Pub. L. 97-35, Sec. 2106(b)(2), struck out provision 
that notice filed by an individual enrolled pursuant to section 1395p(f) 
of this title shall not be considered a disenrollment for purposes of 
section 1395p(b) of this title.
    1980--Subsec. (a)(2)(E). Pub. L. 96-499, Sec. 945(c)(1), substituted 
``the first day of the third month'' for ``the July 1''.
    Subsec. (b). Pub. L. 96-499, Sec. 947(b), inserted ``(except as 
otherwise provided in section 1395v(e) of this title)''.
    1972--Subsec. (a)(1). Pub. L. 92-603, Sec. 201(c)(3)(A), inserted 
``or (in the case of a disabled individual who has not attained age 65) 
July 1, 1973'' after ``July 1, 1966''.
    Subsec. (a)(2). Pub. L. 92-603, Sec. 201(c)(3)(B), substituted in 
subpar. (A) ``paragraph (1) or (2)'' for ``paragraphs (1) and (2)'' and 
in subpars. (B) to (D) ``paragraph'' for ``paragraphs''.
    Subsec. (a)(3). Pub. L. 92-603, Sec. 206(b), added par. (3).
    Subsec. (b). Pub. L. 92-603, Secs. 206(c), 257(a), inserted 
provisions relating to an individual who is deemed to have enrolled for 
medical insurance pursuant to section 1395p(f) of this title and an 
individual who is deemed enrolled for medical insurance benefits 
pursuant to section 1395p(f) of this title and struck out provisions 
limiting the allowable grace period to 90 days and inserted provision 
for extension of such period of up to 180 days where failure to pay 
premiums is due to good cause.
    Subsecs. (c), (d). Pub. L. 92-603, Sec. 202(c)(3)(C), added subsec. 
(c) and redesignated former subsec. (c) as (d).
    1968--Subsec. (b). Pub. L. 90-248 struck out ``, during a general 
enrollment period described in section 1395p(e) of this title,'' after 
``notice'' in par. (1), and substituted in first sentence following par. 
(2) ``the calendar quarter following the calendar quarter'' for 
``December 31 of the year''.


                    Effective Date of 1997 Amendment

    Amendment by Pub. L. 105-33 applicable to involuntary terminations 
of coverage under a group health plan occurring on or after Aug. 5, 
1997, see section 4581(c) of Pub. L. 105-33, set out as a note under 
section 1395p of this title.


                    Effective Date of 1994 Amendment

    Amendment by Pub. L. 103-432 effective on first day of first month 
beginning after expiration of the 120-day period that begins on Oct. 31, 
1994, see section 147(f)(1)(C) of Pub. L. 103-432, set out as a note 
under section 1395p of this title.


                    Effective Date of 1986 Amendments

    Section 9344(b)(2) of Pub. L. 99-509 provided that: ``The amendments 
made by paragraph (1) [amending this section] shall apply to notices 
filed on or after July 1, 1987.''
    Amendment by Pub. L. 99-272 effective May 1, 1986, see section 
9201(d)(2) of Pub. L. 99-272, set out as a note under section 1395p of 
this title.


                    Effective Date of 1984 Amendment

    For effective date of amendment by Pub. L. 98-369, see section 
2338(d)(2) of Pub. L. 98-369, set out as a note under section 1395p of 
this title.


                    Effective Date of 1981 Amendment

    Amendment by section 2106(b)(2) of Pub. L. 97-35 effective Apr. 1, 
1981, see section 2106(c) of Pub. L. 97-35, set out as a note under 
section 1395l of this title.
    Amendment by section 2151(a)(3) of Pub. L. 97-35 not applicable to 
enrollments pursuant to written requests for enrollment filed before 
Oct. 1, 1981, see section 2151(b) of Pub. L. 97-35, set out as a note 
under section 1395p of this title.


                    Effective Date of 1980 Amendment

    Amendment by section 945(c)(1) of Pub. L. 96-499 applicable to 
enrollments occurring on or after Apr. 1, 1981, see section 945(d) of 
Pub. L. 96-499, set out as a note under section 1395p of this title.
    Amendment by section 947(b) of Pub. L. 96-499 applicable to notices 
filed after third calendar month beginning after Dec. 5, 1980, see 
section 947(d) of Pub. L. 96-499, set out as a note under section 1395v 
of this title.


                    Effective Date of 1972 Amendment

    Section 257(b) of Pub. L. 92-603 provided that: ``The amendments 
made by subsection (a) [amending this section] shall apply with respect 
to nonpayment of premiums which become due and payable on or after the 
date of the enactment of this Act [Oct. 30, 1972] or which became 
payable within the 90-day period immediately preceding such date; and 
for purposes of such amendments any premium which became due and payable 
within such 90-day period shall be considered a premium becoming due and 
payable on the date of the enactment of this Act.''


                    Effective Date of 1968 Amendment

    Amendment by Pub. L. 90-248 effective Apr. 1, 1968, see section 
145(e) of Pub. L. 90-248, set out as a note under section 1395p of this 
title.


                   Coverage Period; Termination Dates

    Pub. L. 90-97, Sec. 3(a), Sept. 30, 1967, 81 Stat. 249, provided 
that: ``In the case of any individual who, pursuant to section 
1838(b)(1) of the Social Security Act [subsec. (b)(1) of this section], 
terminates his enrollment in the insurance program established under 
part B of title XVIII of such Act [this part], his coverage period (as 
defined in section 1838(a) of such Act) [subsec. (a) of this section]--
        ``(1) shall terminate at the close of December 31, 1967, if he 
    filed his notice of termination before January 1, 1968, or
        ``(2) shall terminate at the close of March 31, 1968, if he 
    filed his notice of termination after December 31, 1967, and before 
    April 1, 1968.
An individual whose coverage period terminated pursuant to paragraph (1) 
at the close of December 31, 1967, may, notwithstanding section 
1837(b)(2) of such Act [section 1395p(b)(2) of this title], enroll in 
such program before April 1, 1968, and for purposes of sections 
1838(a)(2)(E) [subsec. (a)(2)(E) of this section] and 1837(b)(2) of such 
Act [section 1395p(b)(2) of this title] such enrollment shall be deemed 
an enrollment under section 1837(e) of such Act [section 1395p(e) of 
this title] and a second enrollment under such part.''


   Extension of 1967 General Enrollment Period Through March 31, 1968

    Extension of the general enrollment period under section 1395p(e) of 
this title through March 31, 1968, see section 1 of Pub. L. 90-97, Sept. 
30, 1967, 81 Stat. 249, set out as a note under section 1395p of this 
title.


  Coverage Period for Individuals Becoming Eligible in March 1966 Who 
                           Enroll in May 1966

    Pub. L. 89-384, Sec. 3(d), Apr. 8, 1966, 80 Stat. 105, provided 
that: ``In the case of an individual who first satisfies paragraphs (1) 
and (2) of section 1836 of the Social Security Act [section 1395o of 
this title] in March, 1966, and who enrolls pursuant to subsection (d) 
of section 1837 of such Act [section 1395p of this title] in May 1966, 
his coverage period shall, notwithstanding section 1838(a)(2)(D) of such 
Act [subsec. (a)(2)(D) of this section], begin on July 1, 1966.''


          Commencement of Coverage Period of Certain Enrollees

    Commencement of coverage period upon enrollment before Oct. 1, 1966 
of eligible individuals failing for good cause to enroll before June 1, 
1966, see section 102(b) of Pub. L. 89-97, set out as a note under 
section 1395p of this title.

                  Section Referred to in Other Sections

    This section is referred to in sections 1395i-2, 1395p, 1395w-21 of 
this title.
