{"identifier":"/us/usc/t42/s1395q","title":42,"num":"\u00a7\u202f1395q.","heading":"Coverage period","text":"\u00a7\u202f1395q.\nCoverage period\n(a)\nCommencement\nThe period during which an individual is entitled to benefits under the insurance program established by this part (hereinafter referred to as his \u201ccoverage period\u201d) shall begin on whichever of the following is the latest:\n(1) July 1, 1966\nJuly 1, 1973\n(2)\n(A) in the case of an individual who enrolls pursuant to subsection (d) of\nsection 1395p of this title\no\n(B) in the case of an individual who first satisfies such paragraph in a month beginning before January 2023 and who enrolls pursuant to such subsection (d)\u2014\n(i) in such month in which he first satisfies such paragraph, the first day of the month following the month in which he so enrolls,\n(ii) in the month following such month in which he first satisfies such paragraph, the first day of the second month following the month in which he so enrolls, or\n(iii) more than one month following such month in which he satisfies such paragraph, the first day of the third month following the month in which he so enrolls,\n(C) in the case of an individual who first satisfies such paragraph in a month beginning on or after\nJanuary 1, 2023\n(D) in the case of an individual who enrolls pursuant to subsection (e) of\n(i) before\nJanuary 1, 2023\n(ii) on or after\nJanuary 1, 2023\n(3) in the case of an individual who is deemed to have enrolled\u2014\n(A) 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 1395\no\nJuly 1, 1973\n(B) on or after the first day of the fourth month of his initial enrollment period, and where such month begins\u2014\n(i) before\nJanuary 1, 2023\n(ii) on or after\nJanuary 1, 2023\n(b)\nContinuation\nAn individual\u2019s coverage period shall continue until his enrollment has been terminated\u2014\n(1) by the filing of notice that the individual no longer wishes to participate in the insurance program established by this part, or\n(2) for nonpayment of premiums.\nThe termination of a coverage period under paragraph (1) shall (except as otherwise provided in\nsection 1395v(e) of this title\nWhere an individual who is deemed to have enrolled for medical insurance pursuant to\nsection 1395p(f) of this title\nsection 1395p(n)(3) of this title\nsection 1395p(f) of this title\nsection 1395p(n)(3) of this title\n(c)\nTermination\nIn the case of an individual satisfying paragraph (1) of section 1395\no\n(d)\nPayment of expenses incurred during coverage period\nNo 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.\n(e)\nCommencement of coverage for special enrollment periods\nNotwithstanding subsection (a), 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\u2014\n(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\nsection 1395p(i)(3) of this title\nsection 1395p(i)(4)(A)(i) of this title\n(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.\n(f)\nCommencement of coverage for certain volunteers serving outside United States\nNotwithstanding subsection (a), in the case of an individual who enrolls during a special enrollment period pursuant to\nsection 1395p(k) of this title\n(g)\nSpecial enrollment periods for exceptional circumstances\nNotwithstanding subsection (a), in the case of an individual who enrolls during a special enrollment period pursuant to\nsection 1395p(m) of this title\n(h)\nCoverage period for individuals only eligible for coverage of immunosuppressive drugs\nIn the case of an individual described in section 1395\n(1) In the case of such an individual who is deemed to have enrolled in part B for coverage of immunosuppressive drugs under\nsection 1395p(n)(3) of this title\no\n(2) In the case of such an individual who enrolls (or reenrolls, if applicable) in part B for coverage of immunosuppressive drugs under paragraph (2) or (4) of\nsection 1395p(n) of this title\nJanuary 1, 2023\n(3) The provisions of subsections (b) and (d) shall apply with respect to an individual described in paragraph (1) or (2).\n(4) In addition to the reasons for termination under subsection (b), the coverage period of an individual described in paragraph (1) or (2) shall end when the individual becomes entitled to benefits under this subchapter under subsection (a) or (b) of\nsection 426 of this title\nsection 426\u20131 of this title\no\n(5) The Secretary may conduct public education activities to raise awareness of the availability of more comprehensive, individual health insurance coverage (as defined in\nsection 300gg\u201391 of this title\no\n(i)\nCoverage period for certain Postal Service annuitants and family members\nNotwithstanding subsection (a), in the case of an individual who enrolls during the special enrollment period pursuant to section 1395p(\no\nJanuary 1, 2025","url":"https://projectusc.org/usc/t42/s1395q.html","content":[{"t":"sec","id":"/us/usc/t42/s1395q","children":[{"t":"num","text":"\u00a7\u202f1395q."},{"t":"heading","text":"Coverage period"},{"t":"subsec","id":"/us/usc/t42/s1395q/a","children":[{"t":"num","text":"(a)"},{"t":"heading","text":"Commencement"},{"t":"chapeau","text":"The period during which an individual is entitled to benefits under the insurance program established by this part (hereinafter referred to as his \u201ccoverage period\u201d) shall begin on whichever of the following is the latest:"},{"t":"para","id":"/us/usc/t42/s1395q/a/1","children":[{"t":"num","text":"(1)"},{"t":"content","text":" ","children":[{"t":"text","text":"July 1, 1966","tail":", or (in the case of a disabled individual who has not attained age 65) "},{"t":"text","text":"July 1, 1973","tail":"; or"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1395q/a/2","children":[{"t":"num","text":"(2)"},{"t":"subpara","id":"/us/usc/t42/s1395q/a/2/A","children":[{"t":"num","text":"(A)"},{"t":"content","text":" in the case of an individual who enrolls pursuant to subsection (d) of ","children":[{"t":"ref","text":"section 1395p of this title","href":"/us/usc/t42/s1395p","tail":" before the month in which he first satisfies paragraph (1) or (2) of section 1395"},{"t":"text","text":"o","tail":"(a) of this title, the first day of such month,"}],"tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s1395q/a/2/B","children":[{"t":"num","text":"(B)"},{"t":"chapeau","text":" in the case of an individual who first satisfies such paragraph in a month beginning before January 2023 and who enrolls pursuant to such subsection (d)\u2014"},{"t":"clause","id":"/us/usc/t42/s1395q/a/2/B/i","children":[{"t":"num","text":"(i)"},{"t":"content","text":" in such month in which he first satisfies such paragraph, the first day of the month following the month in which he so enrolls,","tail":"\n"}],"tail":"\n"},{"t":"clause","id":"/us/usc/t42/s1395q/a/2/B/ii","children":[{"t":"num","text":"(ii)"},{"t":"content","text":" in the month following such month in which he first satisfies such paragraph, the first day of the second month following the month in which he so enrolls, or","tail":"\n"}],"tail":"\n"},{"t":"clause","id":"/us/usc/t42/s1395q/a/2/B/iii","children":[{"t":"num","text":"(iii)"},{"t":"content","text":" more than one month following such month in which he satisfies such paragraph, the first day of the third month following the month in which he so enrolls,","tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s1395q/a/2/C","children":[{"t":"num","text":"(C)"},{"t":"content","text":" in the case of an individual who first satisfies such paragraph in a month beginning on or after ","children":[{"t":"text","text":"January 1, 2023","tail":", and who enrolls pursuant to such subsection (d) in such month in which he first satisfies such paragraph or in any subsequent month of his initial enrollment period, the first day of the month following the month in which he so enrolls, or"}],"tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s1395q/a/2/D","children":[{"t":"num","text":"(D)"},{"t":"chapeau","text":" in the case of an individual who enrolls pursuant to subsection (e) of ","children":[{"t":"ref","text":"section 1395p of this title","href":"/us/usc/t42/s1395p","tail":" in a month beginning\u2014"}]},{"t":"clause","id":"/us/usc/t42/s1395q/a/2/D/i","children":[{"t":"num","text":"(i)"},{"t":"content","text":" before ","children":[{"t":"text","text":"January 1, 2023","tail":", the July 1 following the month in which he so enrolls; or"}],"tail":"\n"}],"tail":"\n"},{"t":"clause","id":"/us/usc/t42/s1395q/a/2/D/ii","children":[{"t":"num","text":"(ii)"},{"t":"content","text":" on or after ","children":[{"t":"text","text":"January 1, 2023","tail":", the first day of the month following the month in which he so enrolls; or"}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1395q/a/3","children":[{"t":"num","text":"(3)"},{"t":"chapeau","text":" in the case of an individual who is deemed to have enrolled\u2014"},{"t":"subpara","id":"/us/usc/t42/s1395q/a/3/A","children":[{"t":"num","text":"(A)"},{"t":"content","text":" 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 1395","children":[{"t":"text","text":"o","tail":"(a) of this title or "},{"t":"text","text":"July 1, 1973","tail":", whichever is later, or"}],"tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s1395q/a/3/B","children":[{"t":"num","text":"(B)"},{"t":"chapeau","text":" on or after the first day of the fourth month of his initial enrollment period, and where such month begins\u2014"},{"t":"clause","id":"/us/usc/t42/s1395q/a/3/B/i","children":[{"t":"num","text":"(i)"},{"t":"content","text":" before ","children":[{"t":"text","text":"January 1, 2023","tail":", as prescribed under subparagraphs (B)(i), (B)(ii), (B)(iii), and (D)(i) of paragraph (2), or"}],"tail":"\n"}],"tail":"\n"},{"t":"clause","id":"/us/usc/t42/s1395q/a/3/B/ii","children":[{"t":"num","text":"(ii)"},{"t":"content","text":" on or after ","children":[{"t":"text","text":"January 1, 2023","tail":", as prescribed under subparagraphs (C) and (D)(ii) of paragraph (2)."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"subsec","id":"/us/usc/t42/s1395q/b","children":[{"t":"num","text":"(b)"},{"t":"heading","text":"Continuation"},{"t":"chapeau","text":"An individual\u2019s coverage period shall continue until his enrollment has been terminated\u2014"},{"t":"para","id":"/us/usc/t42/s1395q/b/1","children":[{"t":"num","text":"(1)"},{"t":"content","text":" by the filing of notice that the individual no longer wishes to participate in the insurance program established by this part, or","tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1395q/b/2","children":[{"t":"num","text":"(2)"},{"t":"content","text":" for nonpayment of premiums.","tail":"\n"}],"tail":"\n\n"},{"t":"continuation","text":"The termination of a coverage period under paragraph (1) shall (except as otherwise provided in ","children":[{"t":"ref","text":"section 1395v(e) of this title","href":"/us/usc/t42/s1395v/e","tail":") 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."}],"tail":"\n\n"},{"t":"continuation","text":"Where an individual who is deemed to have enrolled for medical insurance pursuant to ","children":[{"t":"ref","text":"section 1395p(f) of this title","href":"/us/usc/t42/s1395p/f","tail":" or "},{"t":"ref","text":"section 1395p(n)(3) of this title","href":"/us/usc/t42/s1395p/n/3","tail":" 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 "},{"t":"ref","text":"section 1395p(f) of this title","href":"/us/usc/t42/s1395p/f","tail":" or "},{"t":"ref","text":"section 1395p(n)(3) of this title","href":"/us/usc/t42/s1395p/n/3","tail":" 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."}],"tail":"\n"}],"tail":"\n"},{"t":"subsec","id":"/us/usc/t42/s1395q/c","children":[{"t":"num","text":"(c)"},{"t":"heading","text":"Termination"},{"t":"content","children":[{"t":"p","text":"In the case of an individual satisfying paragraph (1) of section 1395","children":[{"t":"text","text":"o","tail":"(a) of this title whose entitlement to hospital insurance benefits under part A 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."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"subsec","id":"/us/usc/t42/s1395q/d","children":[{"t":"num","text":"(d)"},{"t":"heading","text":"Payment of expenses incurred during coverage period"},{"t":"content","children":[{"t":"p","text":"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.","tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"subsec","id":"/us/usc/t42/s1395q/e","children":[{"t":"num","text":"(e)"},{"t":"heading","text":"Commencement of coverage for special enrollment periods"},{"t":"chapeau","text":"Notwithstanding subsection (a), 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\u2014"},{"t":"para","id":"/us/usc/t42/s1395q/e/1","children":[{"t":"num","text":"(1)"},{"t":"content","text":" 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 ","children":[{"t":"ref","text":"section 1395p(i)(3) of this title","href":"/us/usc/t42/s1395p/i/3","tail":" or specified in "},{"t":"ref","text":"section 1395p(i)(4)(A)(i) of this title","href":"/us/usc/t42/s1395p/i/4/A/i","tail":") 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"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1395q/e/2","children":[{"t":"num","text":"(2)"},{"t":"content","text":" 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.","tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"subsec","id":"/us/usc/t42/s1395q/f","children":[{"t":"num","text":"(f)"},{"t":"heading","text":"Commencement of coverage for certain volunteers serving outside United States"},{"t":"content","children":[{"t":"p","text":"Notwithstanding subsection (a), in the case of an individual who enrolls during a special enrollment period pursuant to ","children":[{"t":"ref","text":"section 1395p(k) of this title","href":"/us/usc/t42/s1395p/k","tail":", the coverage period shall begin on the first day of the month following the month in which the individual so enrolls."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"subsec","id":"/us/usc/t42/s1395q/g","children":[{"t":"num","text":"(g)"},{"t":"heading","text":"Special enrollment periods for exceptional circumstances"},{"t":"content","children":[{"t":"p","text":"Notwithstanding subsection (a), in the case of an individual who enrolls during a special enrollment period pursuant to ","children":[{"t":"ref","text":"section 1395p(m) of this title","href":"/us/usc/t42/s1395p/m","tail":", the coverage period shall begin on a date the Secretary provides in a manner consistent (to the extent practicable) with protecting continuity of health benefit coverage."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"subsec","id":"/us/usc/t42/s1395q/h","children":[{"t":"num","text":"(h)"},{"t":"heading","text":"Coverage period for individuals only eligible for coverage of immunosuppressive drugs"},{"t":"chapeau","text":"In the case of an individual described in section 1395","children":[{"t":"text","text":"o","tail":"(b)(1) of this title, the following rules shall apply:"}]},{"t":"para","id":"/us/usc/t42/s1395q/h/1","children":[{"t":"num","text":"(1)"},{"t":"content","text":" In the case of such an individual who is deemed to have enrolled in part B for coverage of immunosuppressive drugs under ","children":[{"t":"ref","text":"section 1395p(n)(3) of this title","href":"/us/usc/t42/s1395p/n/3","tail":", such individual\u2019s coverage period shall begin on the first day of the month in which the individual first satisfies section 1395"},{"t":"text","text":"o","tail":"(b) of this title."}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1395q/h/2","children":[{"t":"num","text":"(2)"},{"t":"content","text":" In the case of such an individual who enrolls (or reenrolls, if applicable) in part B for coverage of immunosuppressive drugs under paragraph (2) or (4) of ","children":[{"t":"ref","text":"section 1395p(n) of this title","href":"/us/usc/t42/s1395p/n","tail":", such individual\u2019s coverage period shall begin on "},{"t":"text","text":"January 1, 2023","tail":", or the month following the month in which the individual so enrolls (or reenrolls), whichever is later."}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1395q/h/3","children":[{"t":"num","text":"(3)"},{"t":"content","text":" The provisions of subsections (b) and (d) shall apply with respect to an individual described in paragraph (1) or (2).","tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1395q/h/4","children":[{"t":"num","text":"(4)"},{"t":"content","text":" In addition to the reasons for termination under subsection (b), the coverage period of an individual described in paragraph (1) or (2) shall end when the individual becomes entitled to benefits under this subchapter under subsection (a) or (b) of ","children":[{"t":"ref","text":"section 426 of this title","href":"/us/usc/t42/s426","tail":", or under "},{"t":"ref","text":"section 426\u20131 of this title","href":"/us/usc/t42/s426\u20131","tail":", or is no longer eligible for such coverage as a result of the application of section 1395"},{"t":"text","text":"o","tail":"(b)(2) of this title."}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1395q/h/5","children":[{"t":"num","text":"(5)"},{"t":"content","text":" The Secretary may conduct public education activities to raise awareness of the availability of more comprehensive, individual health insurance coverage (as defined in ","children":[{"t":"ref","text":"section 300gg\u201391 of this title","href":"/us/usc/t42/s300gg\u201391","tail":") for individuals eligible under section 1395"},{"t":"text","text":"o","tail":"(b) of this title to enroll or to be deemed enrolled in the medical insurance program established under this part for purposes of coverage of immunosuppressive drugs."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"subsec","id":"/us/usc/t42/s1395q/i","children":[{"t":"num","text":"(i)"},{"t":"heading","text":"Coverage period for certain Postal Service annuitants and family members"},{"t":"content","children":[{"t":"p","text":"Notwithstanding subsection (a), in the case of an individual who enrolls during the special enrollment period pursuant to section 1395p(","children":[{"t":"text","text":"o","tail":") of this title, the coverage period shall begin on "},{"t":"text","text":"January 1, 2025","tail":"."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"text","text":"\n"},{"t":"text","text":"\n"}]}]}