42 U.S.C. § 1395s

Current through P.L. 118-107 (published on www.congress.gov on 11/21/2024)

Section 1395s - Payment of premiums

(a) Deductions from section 402 or 423 monthly benefits

(1) In the case of an individual who is entitled to monthly benefits under section 402 or 423 of this title, his monthly premiums under this part shall (except as provided in subsections (b)(1) and (c)) be collected by deducting the amount thereof from the amount of such monthly benefits. Such deduction shall be made in such manner and at such times as the Commissioner of Social Security shall by regulation prescribe. Such regulations shall be prescribed after consultation with the Secretary.

(2) The Secretary of the Treasury shall, from time to time, transfer from the Federal Old-Age and Survivors Insurance Trust Fund or the Federal Disability Insurance Trust Fund to the Federal Supplementary Medical Insurance Trust Fund the aggregate amount deducted under paragraph (1) for the period to which such transfer relates from benefits under section 402 or 423 of this title which are payable from such Trust Fund. Such transfer shall be made on the basis of a certification by the Commissioner of Social Security and shall be appropriately adjusted to the extent that prior transfers were too great or too small.

(b) Deductions from railroad retirement annuities or pensions

(1) In the case of an individual who is entitled to receive for a month an annuity under the Railroad Retirement Act of 1974 [45 U.S.C. 231 et seq.] (whether or not such individual is also entitled for such month to a monthly insurance benefit under section 402 of this title), his monthly premiums under this part shall (except as provided in subsection (c)) be collected by deducting the amount thereof from such annuity or pension. Such deduction shall be made in such manner and at such times as the Secretary shall by regulations prescribe. Such regulations shall be prescribed only after consultation with the Railroad Retirement Board.

(2) The Secretary of the Treasury shall, from time to time, transfer from the Railroad Retirement Account to the Federal Supplementary Medical Insurance Trust Fund the aggregate amount deducted under paragraph (1) for the period to which such transfer relates. Such transfers shall be made on the basis of a certification by the Railroad Retirement Board and shall be appropriately adjusted to the extent that prior transfers were too great or too small.

(c) Portion of monthly premium in excess of deducted amount

If an individual to whom subsection (a) or (b) applies estimates that the amount which will be available for deduction under such subsection for any premium payment period will be less than the amount of the monthly premiums for such period, he may (under regulations) pay to the Secretary such portion of the monthly premiums for such period as he desires.

(d) Deductions from civil service retirement annuities

(1) In the case of an individual receiving an annuity under subchapter III of chapter 83 of title 5 or any other law administered by the Director of the Office of Personnel Management providing retirement or survivorship protection, to whom neither subsection (a) nor subsection (b) applies, his monthly premiums under this part (and the monthly premiums of the spouse of such individual under this part if neither subsection (a) nor subsection (b) applies to such spouse and if such individual agrees) shall, upon notice from the Secretary of Health and Human Services to the Director of the Office of Personnel Management, be collected by deducting the amount thereof from each installment of such annuity. Such deduction shall be made in such manner and at such times as the Director of the Office of Personnel Management may determine. The Director of the Office of Personnel Management shall furnish such information as the Secretary of Health and Human Services may reasonably request in order to carry out his functions under this part with respect to individuals to whom this subsection applies. A plan described in section 8903 or 8903a of title 5 may reimburse each annuitant enrolled in such plan an amount equal to the premiums paid by him under this part if such reimbursement is paid entirely from funds of such plan which are derived from sources other than the contributions described in section 8906 of such title.

(2) The Secretary of the Treasury shall, from time to time, but not less often than quarterly, transfer from the Civil Service Retirement and Disability Fund, or the account (if any) applicable in the case of such other law administered by the Director of the Office of Personnel Management, to the Federal Supplementary Medical Insurance Trust Fund the aggregate amount deducted under paragraph (1) for the period to which such transfer relates. Such transfer shall be made on the basis of a certification by the Director of the Office of Personnel Management and shall be appropriately adjusted to the extent that prior transfers were too great or too small.

(e) Manner and time of payment prescribed by Secretary

In the case of an individual who participates in the insurance program established by this part but with respect to whom none of the preceding provisions of this section applies, or with respect to whom subsection (c) applies, the premiums shall be paid to the Secretary at such times, and in such manner, as the Secretary shall by regulations prescribe.

(f) Deposit of amounts in Treasury

Amounts paid to the Secretary under subsection (c) or (e) shall be deposited in the Treasury to the credit of the Federal Supplementary Medical Insurance Trust Fund.

(g) Premium payability period

In the case of an individual who participates in the insurance program established by this part, premiums shall be payable for the period commencing with the first month of his coverage period and ending with the month in which he dies or, if earlier, in which his coverage under such program terminates.

(h) Exempted monthly benefits

In the case of an individual who is enrolled under the program established by this part as a member of a coverage group to which an agreement with a State entered into pursuant to section 1395v of this title is applicable, subsections (a), (b), (c), and (d) of this section shall not apply to his monthly premium for any month in his coverage period which is determined under section 1395v(d) of this title.

(i) Adjustments for individuals enrolled in Medicare+Choice plans

In the case of an individual enrolled in a Medicare+Choice plan, the Secretary shall provide for necessary adjustments of the monthly beneficiary premium to reflect 80 percent of any reduction elected under section 1395w-24(f)(1)(E) of this title and to reflect any credit provided under section 1395w-24(b)(1)(C)(iv) ¹ of this title. To the extent to which the Secretary determines that such an adjustment is appropriate, with the concurrence of any agency responsible for the administration of such benefits, such premium adjustment may be provided directly, as an adjustment to any social security, railroad retirement, or civil service retirement benefits, or, in the case of an individual who receives medical assistance under subchapter XIX for medicare costs described in section 1396d(p)(3)(A)(ii) of this title, as an adjustment to the amount otherwise owed by the State for such medical assistance.

¹ See References in Text note below.

42 U.S.C. § 1395s

Aug. 14, 1935, ch. 531, title XVIII, §1840, as added Pub. L. 89-97, title I, §102(a), July 30, 1965, 79 Stat. 306; amended Pub. L. 89-384, §4(c), Apr. 8, 1966, 80 Stat. 106; Pub. L. 90-248, title I, §166, title IV, §403(g), Jan. 2, 1968, 81 Stat. 874, 932; Pub. L. 92-603, title II, §§201(c)(6), 263 (3), Oct. 30, 1972, 86 Stat. 1373, 1448, 1449; Pub. L. 93-445, title III, §306, Oct. 16, 1974, 88 Stat. 1358; Pub. L. 98-369, div. B, title III, §2354(b)(11), title VI, §2663(j)(2)(F)(ii), July 18, 1984, 98 Stat. 1101, 1170; Pub. L. 99-53, §2(g), June 17, 1985, 99 Stat. 94; Pub. L. 100-360, title II, §212(b)(1), July 1, 1988, 102 Stat. 740; Pub. L. 100-485, title VI, §608(d) (10)(B), Oct. 13, 1988, 102 Stat. 2415; Pub. L. 101-234, title II, §202(a), Dec. 13, 1989, 103 Stat. 1981; Pub. L. 103-296, title I, §108(c)(2), Aug. 15, 1994, 108 Stat. 1485; Pub. L. 106-554, §1(a)(6) [title VI, §606(a)(2)(B)(ii)], Dec. 21, 2000, 114 Stat. 2763, 2763A-557; Pub. L. 108-173, title II, §222(l)(2)(B), Dec. 8, 2003, 117 Stat. 2206.

EDITORIAL NOTES

REFERENCES IN TEXTThe Railroad Retirement Act of 1974, referred to in subsec. (b)(1), is act Aug. 29, 1935, ch. 812, as amended generally by Pub. L. 93-445, title I, §101, Oct. 16, 1974, 88 Stat. 1305, which is classified generally to subchapter IV (§231 et seq.) of chapter 9 of Title 45, Railroads. For further details and complete classification of this Act to the Code, see Codification note set out preceding section 231 of Title 45, section 231t of Title 45, and Tables. Section 1395w-24(b)(1)(C)(iv) of this title, referred to in subsec. (i), was redesignated section 1395w-24(b)(1)(C)(v) of this title by Pub. L. 111-148, title III, §3202(b)(1)(B), Mar. 23, 2010, 124 Stat. 454, and subsequently redesignated section 1395w-24(b)(1)(C)(viii) of this title by Pub. L. 111-152, title I, §1102(d)(2), Mar. 30, 2010, 124 Stat. 1045.

AMENDMENTS2003-Subsec. (i). Pub. L. 108-173 inserted "and to reflect any credit provided under section 1395w-24(b)(1)(C)(iv) of this title" after "section 1395w-24(f)(1)(E) of this title" in first sentence. 2000-Subsec. (i). Pub. L. 106-554 added subsec. (i).1994-Subsec. (a)(1). Pub. L. 103-296, §108(c)(2)(A), substituted "Commissioner of Social Security" for "Secretary" and inserted at end "Such regulations shall be prescribed after consultation with the Secretary."Subsec. (a)(2). Pub. L. 103-296, §108(c)(2)(B), substituted "Commissioner of Social Security" for "Secretary of Health and Human Services". 1989-Subsec. (i). Pub. L. 101-234 repealed Pub. L. 100-360, §212(b)(1), and provided that the provisions of law amended or repealed by such section are restored or revised as if such section had not been enacted, see 1988 Amendment note below. 1988-Subsec. (i). Pub. L. 100-485 substituted "Supplementary" for "Supplemental". Pub. L. 100-360 added subsec. (i) relating to transfer to flat prescription drug premiums to Federal Catastrophic Drug Insurance Trust Fund. 1985-Subsec. (d)(1). Pub. L. 99-53 inserted reference to section 8903a of title 5.1984-Subsec. (a)(2). Pub. L. 98-369, §2663(j)(2)(F)(ii), substituted "Health and Human Services" for "Health, Education, and Welfare".Subsec. (d)(1). Pub. L. 98-369, §2354(b)(11), substituted "Director of the Office of Personnel Management" for "Civil Service Commission". Pub. L. 98-369, §2663(j)(2)(F)(ii), substituted "Health and Human Services" for "Health, Education, and Welfare".Subsec. (d)(2). Pub. L. 98-369, §2354(b)(11), substituted "Director of the Office of Personnel Management" for "Civil Service Commission". 1974-Subsec. (b)(1). Pub. L. 93-445 substituted "under the Railroad Retirement Act of 1974" for "or pension under the Railroad Retirement Act of 1937". 1972-Subsec. (a)(1). Pub. L. 92-603, §§201(c)(6)(A), 263, substituted "subsections (b)(1) and (c)" for "subsection (d)" and inserted reference to section 423 of this title.Subsec. (a)(2). Pub. L. 92-603, §201(c)(6)(B), inserted reference to section 423 of this title. Subsec. (b)(1). Pub. L. 92-603, §263(b), inserted "(whether or not such individual is also entitled for such month to a monthly insurance benefit under section 402 of this title)" after "1937" and substituted "subsection (c)" for "subsection (d)".Subsec. (c). Pub. L. 92-603, §263(c), struck out subsec. (c) covering individuals entitled both to monthly benefits under section 402 of this title and to an annuity or pension under Railroad Retirement Act of 1937 and redesignated former subsec. (d) as (c).Subsec. (d). Pub. L. 92-603, §263(c), redesignated subsec. (e) as (d). Former subsec. (d) redesignated (c). Subsec. (e). Pub. L. 92-603, §263(c), (d) (1), redesignated subsec. (f) as (e) and substituted "subsection (c)" for "subsection (d)". Former subsec. (e) redesignated (d). Subsec. (f). Pub. L. 92-603, §263(c), (d) (2), redesignated subsec. (g) as (f) and substituted "subsections (c) or (e)" for "subsections (d) or (f)". Former subsec. (f) redesignated (e) and amended.Subsec. (g). Pub. L. 92-603, §263(c), redesignated subsec. (h) as (g). Former subsec. (g) redesignated (f) and amended.Subsecs. (h), (i). Pub. L. 92-603, §263(c), (d) (3), redesignated subsec. (i) as (h) and substituted "(c) and (d)" for "(c), (d), and (e)". Former subsec. (h) redesignated (g). 1968-Subsec. (e). Pub. L. 90-248 provided for reimbursement of civil service retirement annuitants for certain premium payments under supplementary medical insurance program, and substituted "subchapter III of chapter 83 of Title 5 or any other law" and "such other law" for "the Civil Service Retirement Act, or other Act" and "such other Act", in pars. (1) and (2), respectively.1966-Subsec. (i). Pub. L. 89-384 added subsec. (i).

STATUTORY NOTES AND RELATED SUBSIDIARIES

CHANGE OF NAME References to Medicare+Choice deemed to refer to Medicare Advantage or MA, subject to an appropriate transition provided by the Secretary of Health and Human Services in the use of those terms, see section 201 of Pub. L. 108-173 set out as a note under section 1395w-21 of Title 42, The Public Health and Welfare.

EFFECTIVE DATE OF 2003 AMENDMENT Amendment by Pub. L. 108-173 applicable with respect to plan years beginning on or after Jan. 1, 2006, see section 223(a) of Pub. L. 108-173 set out as a note under section 1395w-21 of this title.

EFFECTIVE DATE OF 2000 AMENDMENT Amendment by Pub. L. 106-554 applicable to years beginning with 2003, see section 1(a)(6) [title VI, §606(b)] of Pub. L. 106-554 set out as a note under section 1395r of this title.

EFFECTIVE DATE OF 1994 AMENDMENT Amendment by Pub. L. 103-296 effective Mar. 31, 1995, see section 110(a) of Pub. L. 103-296 set out as a note under section 401 of this title.

EFFECTIVE DATE OF 1989 AMENDMENT Amendment by Pub. L. 101-234 effective Jan. 1, 1990, see section 202(b) of Pub. L. 101-234 set out as a note under section 401 of this title.

EFFECTIVE DATE OF 1988 AMENDMENT Amendment by Pub. L. 100-485 effective as if included in the enactment of the Medicare Catastrophic Coverage Act of 1988, Pub. L. 100-360, see section 608(g)(1) of Pub. L. 100-485 set out as a note under section 704 of this title.

EFFECTIVE DATE OF 1984 AMENDMENT Amendment by section 2354(b)(11) of Pub. L. 98-369 effective July 18, 1984, but not to be construed as changing or affecting any right, liability, status, or interpretation which existed (under the provisions of law involved) before that date, see section 2354(e)(1) of Pub. L. 98-369 set out as a note under section 1320a-1 of this title.Amendment by section 2663(j)(2)(F)(ii) of Pub. L. 98-369 effective July 18, 1984, but not to be construed as changing or affecting any right, liability, status, or interpretation which existed (under the provisions of law involved) before that date, see section 2664(b) of Pub. L. 98-369 set out as a note under section 401 of this title.

EFFECTIVE DATE OF 1974 AMENDMENT Amendment by Pub. L. 93-445 effective Jan. 1, 1975, see section 603 of Pub. L. 93-445 set out as a note under section 402 of this title.

EFFECTIVE DATE OF 1972 AMENDMENT Pub. L. 92-603, title II, §263(f), Oct. 30, 1972, 86 Stat. 1449, provided that: "The amendments made by this section [amending this section and sections 1395t and 1395u of this title] with respect to collection of premiums shall apply to premiums becoming due and payable after the fourth month following the month in which this Act is enacted [October 1972]."

Director

the term "Director" means the Chief Executive Officer of the Corporation for National and Community Service,

Secretary

the term "Secretary" means- (A) the Secretary of Education for purposes of subtitle A (other than section 3201),(B) the Secretary of Agriculture for purposes of the amendments made by section 3201, and(C) the Secretary of Health and Human Services for purposes of subtitle B,

drug

the term "drug" means- (A) a beverage containing alcohol,(B) a controlled substance, or(C) a controlled substance analogue,