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U.S. Code as of:
01/19/04
Section 1395i-2. Hospital insurance benefits for uninsured elderly individuals not otherwise eligible
(a) Individuals eligible to enroll
Every individual who -
(1) has attained the age of 65,
(2) is enrolled under part B of this subchapter,
(3) is a resident of the United States, and is either (A) a
citizen or (B) an alien lawfully admitted for permanent residence
who has resided in the United States continuously during the 5
years immediately preceding the month in which he applies for
enrollment under this section, and
(4) is not otherwise entitled to benefits under this part,
shall be eligible to enroll in the insurance program established by
this part. Except as otherwise provided, any reference to an
individual entitled to benefits under this part includes an
individual entitled to benefits under this part pursuant to an
enrollment under this section or section 1395i-2a of this title.
(b) Time, manner, and form of enrollment
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.
(c) Period of enrollment; scope of coverage
The provisions of section 1395p of this title (except subsection
(f) thereof), section 1395q of this title, subsection (b) of
section 1395r of this title, and subsections (f) and (h) of section
1395s of this title shall apply to persons authorized to enroll
under this section except that -
(1) individuals who meet the conditions of subsection (a)(1),
(3), and (4) of this section on or before the last day of the
seventh month after October 1972 may enroll under this part and
(if not already so enrolled) may also enroll under part B of this
subchapter during an initial general enrollment period which
shall begin on the first day of the second month which begins
after October 30, 1972, and shall end on the last day of the
tenth month after October 1972;
(2) in the case of an individual who first meets the conditions
of eligibility under this section on or after the first day of
the eighth month after October 1972, the initial enrollment
period shall begin on the first day of the third month before the
month in which he first becomes eligible and shall end 7 months
later;
(3) in the case of an individual who enrolls pursuant to
paragraph (1) of this subsection, entitlement to benefits shall
begin on -
(A) the first day of the second month after the month in
which he enrolls,
(B) July 1, 1973, or
(C) the first day of the first month in which he meets the
requirements of subsection (a) of this section,
whichever is the latest;
(4) an individual's entitlement under this section shall
terminate with the month before the first month in which he
becomes eligible for hospital insurance benefits under section
426 of this title or section 426a of this title; and upon such
termination, such individual shall be deemed, solely for purposes
of hospital insurance entitlement, to have filed in such first
month the application required to establish such entitlement;
(5) termination of coverage for supplementary medical insurance
shall result in simultaneous termination of hospital insurance
benefits for uninsured individuals who are not otherwise entitled
to benefits under this chapter;
(6) any percent increase effected under section 1395r(b) of
this title in an individual's monthly premium may not exceed 10
percent and shall only apply to premiums paid during a period
equal to twice the number of months in the full 12-month periods
described in that section and shall be subject to reduction in
accordance with subsection (d)(6) of this section;
(7) an individual who meets the conditions of subsection (a) of
this section may enroll under this part during a special
enrollment period that includes any month during any part of
which the individual is enrolled under section 1395mm of this
title with an eligible organization and ending with the last day
of the 8th consecutive month in which the individual is at no
time so enrolled;
(8) in the case of an individual who enrolls during a special
enrollment period under paragraph (7) -
(A) in any month of the special enrollment period in which
the individual is at any time enrolled under section 1395mm of
this title with an eligible organization 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
(B) 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; and
(9) in applying the provisions of section 1395r(b) of this
title, there shall not be taken into account months for which the
individual can demonstrate that the individual was enrolled under
section 1395mm of this title with an eligible organization.
(d) Monthly premiums
(1) The Secretary shall, during September of each year (beginning
with 1988), estimate the monthly actuarial rate for months in the
succeeding year. Such actuarial rate shall be one-twelfth of the
amount which the Secretary estimates (on an average, per capita
basis) is equal to 100 percent of the benefits and administrative
costs which will be payable from the Federal Hospital Insurance
Trust Fund for services performed and related administrative costs
incurred in the succeeding year with respect to individuals age 65
and over who will be entitled to benefits under this part during
that year.
(2) The Secretary shall, during September of each year )1(!
determine and promulgate the dollar amount which shall be
applicable for premiums for months occurring in the following year.
Subject to paragraphs (4) and (5), the amount of an individual's
monthly premium under this section shall be equal to the monthly
actuarial rate determined under paragraph (1) for that following
year. Any amount determined under the preceding sentence which is
not a multiple of $1 shall be rounded to the nearest multiple of $1
(or, if it is a multiple of 50 cents but not a multiple of $1, to
the next higher multiple of $1).
(3) Whenever the Secretary promulgates the dollar amount which
shall be applicable as the monthly premium under this section, he
shall, at the time such promulgation is announced, issue a public
statement setting forth the actuarial assumptions and bases
employed by him in arriving at the amount of an adequate actuarial
rate for individuals 65 and older as provided in paragraph (1).
(4)(A) In the case of an individual described in subparagraph
(B), the monthly premium for a month shall be reduced by the
applicable reduction percent specified in the following table:
The applicable
reduction
For a month in: percent is:
1994 25 percent
1995 30 percent
1996 35 percent
1997 40 percent
1998 or subsequent year 45 percent.
(B) An individual described in this subparagraph with respect to
a month is an individual who establishes to the satisfaction of the
Secretary that, as of the last day of the previous month, the
individual -
(i) had at least 30 quarters of coverage under subchapter II of
this chapter;
(ii) was married (and had been married for the previous 1-year
period) to an individual who had at least 30 quarters of coverage
under such subchapter;
(iii) had been married to an individual for a period of at
least 1 year (at the time of such individual's death) if at such
time the individual had at least 30 quarters of coverage under
such subchapter; or
(iv) is divorced from an individual and had been married to the
individual for a period of at least 10 years (at the time of the
divorce) if at such time the individual had at least 30 quarters
of coverage under such subchapter.
(5)(A) The amount of the monthly premium shall be zero in the
case of an individual who is a person described in subparagraph (B)
for a month, if -
(i) the individual's premium under this section for the month
is not (and will not be) paid for, in whole or in part, by a
State (under subchapter XIX of this chapter or otherwise), a
political subdivision of a State, or an agency or instrumentality
of one or more States or political subdivisions thereof; and
(ii) in each of 84 months before such month, the individual was
enrolled in this part under this section and the payment of the
individual's premium under this section for the month was not
paid for, in whole or in part, by a State (under subchapter XIX
of this chapter or otherwise), a political subdivision of a
State, or an agency or instrumentality of one or more States or
political subdivisions thereof.
(B) A person described in this subparagraph for a month is a
person who establishes to the satisfaction of the Secretary that,
as of the last day of the previous month -
(i)(I) the person was receiving cash benefits under a qualified
State or local government retirement system (as defined in
subparagraph (C)) on the basis of the person's employment in one
or more positions covered under any such system, and (II) the
person would have at least 40 quarters of coverage under
subchapter II of this chapter if remuneration for medicare
qualified government employment (as defined in paragraph (1) of
section 410(p) of this title, but determined without regard to
paragraph (3) of such section) paid to such person were treated
as wages paid to such person and credited for purposes of
determining quarters of coverage under section 413 of this title;
(ii)(I) the person was married (and had been married for the
previous 1-year period) to an individual who is described in
clause (i), or (II) the person met the requirement of clause
(i)(II) and was married (and had been married for the previous
1-year period) to an individual described in clause (i)(I);
(iii) the person had been married to an individual for a period
of at least 1 year (at the time of such individual's death) if
(I) the individual was described in clause (i) at the time of the
individual's death, or (II) the person met the requirement of
clause (i)(II) and the individual was described in clause (i)(I)
at the time of the individual's death; or
(iv) the person is divorced from an individual and had been
married to the individual for a period of at least 10 years (at
the time of the divorce) if (I) the individual was described in
clause (i) at the time of the divorce, or (II) the person met the
requirement of clause (i)(II) and the individual was described in
clause (i)(I) at the time of the divorce.
(C) For purposes of subparagraph (B)(i)(I), the term "qualified
State or local government retirement system" means a retirement
system that -
(i) is established or maintained by a State or political
subdivision thereof, or an agency or instrumentality of one or
more States or political subdivisions thereof;
(ii) covers positions of some or all employees of such a State,
subdivision, agency, or instrumentality; and
(iii) does not adjust cash retirement benefits based on
eligibility for a reduction in premium under this paragraph.
(6)(A) In the case where a State, a political subdivision of a
State, or an agency or instrumentality of a State or political
subdivision thereof determines to pay, for the life of each
individual, the monthly premiums due under paragraph (1) on behalf
of each of the individuals in a qualified State or local government
retiree group who meets the conditions of subsection (a) of this
section, the amount of any increase otherwise applicable under
section 1395r(b) of this title (as applied and modified by
subsection (c)(6) of this section) with respect to the monthly
premium for benefits under this part for an individual who is a
member of such group shall be reduced by the total amount of taxes
paid under section 3101(b) of the Internal Revenue Code of 1986 by
such individual and under section 3111(b) of such Code by the
employers of such individual on behalf of such individual with
respect to employment (as defined in section 3121(b) of such Code).
(B) For purposes of this paragraph, the term "qualified State or
local government retiree group" means all of the individuals who
retire prior to a specified date that is before January 1, 2002,
from employment in one or more occupations or other broad classes
of employees of -
(i) the State;
(ii) a political subdivision of the State; or
(iii) an agency or instrumentality of the State or political
subdivision of the State.
(e) Contract or other arrangement for payment of monthly premiums
Payment of the monthly premiums on behalf of any individual who
meets the conditions of subsection (a) of this section may be made
by any public or private agency or organization under a contract or
other arrangement entered into between it and the Secretary if the
Secretary determines that payment of such premiums under such
contract or arrangement is administratively feasible.
(f) Deposit of amounts into Treasury
Amounts paid to the Secretary for coverage under this section
shall be deposited in the Treasury to the credit of the Federal
Hospital Insurance Trust Fund.
(g) Buy-in under this part for qualified medicare beneficiaries
(1) The Secretary shall, at the request of a State made after
1989, enter into a modification of an agreement entered into with
the State pursuant to section 1395v(a) of this title under which
the agreement provides for enrollment in the program established by
this part of qualified medicare beneficiaries (as defined in
section 1396d(p)(1) of this title).
(2)(A) Except as provided in subparagraph (B), the provisions of
subsections (c), (d), (e), and (f) of section 1395v of this title
shall apply to qualified medicare beneficiaries enrolled, pursuant
to such agreement, in the program established by this part in the
same manner and to the same extent as they apply to qualified
medicare beneficiaries enrolled, pursuant to such agreement, in
part B of this subchapter.
(B) For purposes of this subsection, section 1395v(d)(1) of this
title shall be applied by substituting "section 1395i-2 of this
title" for "section 1395r of this title" and "subsection (c)(6)
(with reference to subsection (b) of section 1395r of this title)"
for "subsection (b)".
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