US Code

Public Law 119-73 (01/23/2026)

42 U.S.C. § 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)
, or (in the case of a disabled individual who has not attained age 65) ; or
(2)
(A)
section 1395p of this titleo in the case of an individual who enrolls pursuant to subsection (d) of before the month in which he first satisfies paragraph (1) or (2) of section 1395(a) of this title, the first day of such month,
(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)—
(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,
(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
(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,
(C)
in the case of an individual who first satisfies such paragraph in a month beginning on or after , 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
(D)
section 1395p of this title in the case of an individual who enrolls pursuant to subsection (e) of in a month beginning—
(i)
before , the July 1 following the month in which he so enrolls; or
(ii)
on or after , the first day of the month following the month in which he so enrolls; or
(3)
in the case of an individual who is deemed to have enrolled—
(A)
o 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(a) of this title or , whichever is later, or
(B)
on or after the first day of the fourth month of his initial enrollment period, and where such month begins—
(i)
before , as prescribed under subparagraphs (B)(i), (B)(ii), (B)(iii), and (D)(i) of paragraph (2), or
(ii)
on or after , as prescribed under subparagraphs (C) and (D)(ii) of paragraph (2).
(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.
section 1395v(e) of this titleThe termination of a coverage period under paragraph (1) shall (except as otherwise provided in ) 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.
section 1395p(f) of this titlesection 1395p(n)(3) of this titlesection 1395p(f) of this titlesection 1395p(n)(3) of this titleWhere an individual who is deemed to have enrolled for medical insurance pursuant to or 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 or 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

oIn the case of an individual satisfying paragraph (1) of section 1395(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.

(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), 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)
section 1395p(i)(3) of this titlesection 1395p(i)(4)(A)(i) of this title 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 or specified in ) 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.
(f)

Commencement of coverage for certain volunteers serving outside United States

section 1395p(k) of this titleNotwithstanding subsection (a), in the case of an individual who enrolls during a special enrollment period pursuant to , the coverage period shall begin on the first day of the month following the month in which the individual so enrolls.

(g)

Special enrollment periods for exceptional circumstances

section 1395p(m) of this titleNotwithstanding subsection (a), in the case of an individual who enrolls during a special enrollment period pursuant to , 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.

(h)

Coverage period for individuals only eligible for coverage of immunosuppressive drugs

oIn the case of an individual described in section 1395(b)(1) of this title, the following rules shall apply:
(1)
section 1395p(n)(3) of this titleo In the case of such an individual who is deemed to have enrolled in part B for coverage of immunosuppressive drugs under , such individual’s coverage period shall begin on the first day of the month in which the individual first satisfies section 1395(b) of this title.
(2)
section 1395p(n) of this title 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 , such individual’s coverage period shall begin on , or the month following the month in which the individual so enrolls (or reenrolls), whichever is later.
(3)
The provisions of subsections (b) and (d) shall apply with respect to an individual described in paragraph (1) or (2).
(4)
section 426 of this titlesection 426–1 of this titleo 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 , or under , or is no longer eligible for such coverage as a result of the application of section 1395(b)(2) of this title.
(5)
section 300gg–91 of this titleo The Secretary may conduct public education activities to raise awareness of the availability of more comprehensive, individual health insurance coverage (as defined in ) for individuals eligible under section 1395(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.
(i)

Coverage period for certain Postal Service annuitants and family members

oNotwithstanding subsection (a), in the case of an individual who enrolls during the special enrollment period pursuant to section 1395p() of this title, the coverage period shall begin on .

Aug. 14, 1935, ch. 531Pub. L. 89–97, title I, § 102(a)79 Stat. 305Pub. L. 90–248, title I, § 145(c)81 Stat. 859Pub. L. 92–603, title II86 Stat. 1373Pub. L. 96–499, title IX94 Stat. 2642Pub. L. 97–35, title XXI95 Stat. 792Pub. L. 98–369, div. B, title III, § 2338(c)98 Stat. 1092Pub. L. 99–272, title IX, § 9201(c)(2)100 Stat. 171Pub. L. 99–509, title IX, § 9344(b)(1)100 Stat. 2042Pub. L. 103–432, title I, § 147(f)(1)(B)108 Stat. 4430Pub. L. 105–33, title IV, § 4581(b)(2)111 Stat. 465Pub. L. 108–173, title VII, § 736(b)(6)117 Stat. 2356Pub. L. 109–171, title V, § 5115(a)(2)(B)120 Stat. 46Pub. L. 116–260, div. CC, title I, § 120(a)(1)134 Stat. 2953Pub. L. 117–108, title I, § 101(b)(2)(B)136 Stat. 1136(, title XVIII, § 1838, as added , , ; amended , , ; , §§ 201(c)(3), 206(b), (c), 257(a), , , 1378, 1447; , §§ 945(c)(1), 947(b), , , 2643; , §§ 2106(b)(2), 2151(a)(3), , , 802; , , ; , , ; , , ; , , ; , , ; , , ; , , ; , (2)(B), title IV, § 402(a)(2)(B)(i), (c), , , 2954, 2999, 3000; , , .)

Editorial Notes

Amendments

Pub. L. 117–1082022—Subsec. (i). added subsec. (i).

Pub. L. 116–260, § 120(a)(1)(A)section 1395p(d) of this title2020—Subsec. (a)(2). , amended par. (2) generally. Prior to amendment, par. (2) related to coverage period for individuals enrolling pursuant to .

Pub. L. 116–260, § 120(a)(1)(B)Subsec. (a)(3). , amended par. (3) generally. Prior to amendment, par. (3) read as follows:

o“(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 1395 of this title or , 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.”

Pub. L. 116–260, § 402(c)(2)section 1395p(n)(3) of this titlesection 1395p(f) of this titleSubsec. (b). , inserted in concluding provisions “or ” after “” in two places.

Pub. L. 116–260, § 402(a)(2)(B)(i)ooSubsec. (c). , substituted “section 1395(a) of this title” for “section 1395 of this title”.

Pub. L. 116–260, § 120(a)(2)(B)Subsec. (g). , added subsec. (g).

Pub. L. 116–260, § 402(c)(1)Subsec. (h). , added subsec. (h).

Pub. L. 109–1712006—Subsec. (f). added subsec. (f).

Pub. L. 108–1732003—Subsec. (a)(1). inserted comma after “1966”.

Pub. L. 105–33section 1395p(i)(4)(A)(i) of this title1997—Subsec. (e). inserted “or 1395p(i)(4)(B)” after “1395p(i)(3)” in introductory provisions and “or specified in ” after “1395p(i)(3) of this title” in par. (1).

Pub. L. 103–4321994—Subsec. (e). 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.”

Pub. L. 99–5091986—Subsec. (b). substituted “month following the month” for “calendar quarter following the calendar quarter” in second and sixth sentences.

Pub. L. 99–272Subsec. (e). 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—

section 1395p(i)(3) of this title“(1) subparagraph (A) of —

“(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

section 1395p(i)(3) of this title“(2) subparagraph (B) of —

“(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.”

Pub. L. 98–369, § 2338(c)1984—Subsec. (e). , added subsec. (e).

Pub. L. 97–35, § 2151(a)(3)1981—Subsec. (a)(2)(E). , substituted “the July 1 following” for “the first day of the third month following”.

Pub. L. 97–35, § 2106(b)(2)section 1395p(f) of this titlesection 1395p(b) of this titleSubsec. (b). , struck out provision that notice filed by an individual enrolled pursuant to shall not be considered a disenrollment for purposes of .

Pub. L. 96–499, § 945(c)(1)1980—Subsec. (a)(2)(E). , substituted “the first day of the third month” for “the July 1”.

Pub. L. 96–499, § 947(b)section 1395v(e) of this titleSubsec. (b). , inserted “(except as otherwise provided in )”.

Pub. L. 92–603, § 201(c)(3)(A)1972—Subsec. (a)(1). , inserted “or (in the case of a disabled individual who has not attained age 65) ” after “”.

Pub. L. 92–603, § 201(c)(3)(B)Subsec. (a)(2). , substituted in subpar. (A) “paragraph (1) or (2)” for “paragraphs (1) and (2)” and in subpars. (B) to (D) “paragraph” for “paragraphs”.

Pub. L. 92–603, § 206(b)Subsec. (a)(3). , added par. (3).

Pub. L. 92–603section 1395p(f) of this titlesection 1395p(f) of this titleSubsec. (b). , §§ 206(c), 257(a), inserted provisions relating to an individual who is deemed to have enrolled for medical insurance pursuant to and an individual who is deemed enrolled for medical insurance benefits pursuant to 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.

Pub. L. 92–603, § 202(c)(3)(C)Subsecs. (c), (d). , added subsec. (c) and redesignated former subsec. (c) as (d).

Pub. L. 90–248section 1395p(e) of this title1968—Subsec. (b). struck out “, during a general enrollment period described in ,” 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”.

Statutory Notes and Related Subsidiaries

Effective Date of 2006 Amendment

Pub. L. 109–171section 5115(b) of Pub. L. 109–171section 1395p of this titleAmendment by effective , see , set out as a note under .

Effective Date of 1997 Amendment

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

Effective Date of 1994 Amendment

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

Effective Date of 1986 Amendment

Pub. L. 99–509, title IX, § 9344(b)(2)100 Stat. 2042

“The amendments made by paragraph (1) [amending this section] shall apply to notices filed on or after .”
, , , provided that:

Pub. L. 99–272section 9201(d)(2) of Pub. L. 99–272section 1395p of this titleAmendment by effective , see , set out as a note under .

Effective Date of 1984 Amendment

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

Effective Date of 1981 Amendment

section 2106(b)(2) of Pub. L. 97–35section 2106(c) of Pub. L. 97–35lAmendment by effective , see , set out as a note under section 1395 of this title.

section 2151(a)(3) of Pub. L. 97–35section 2151(b) of Pub. L. 97–35section 1395p of this titleAmendment by not applicable to enrollments pursuant to written requests for enrollment filed before , see , set out as a note under .

Effective Date of 1980 Amendment

section 945(c)(1) of Pub. L. 96–499section 945(d) of Pub. L. 96–499section 1395p of this titleAmendment by applicable to enrollments occurring on or after , see , set out as a note under .

section 947(b) of Pub. L. 96–499section 947(d) of Pub. L. 96–499section 1395v of this titleAmendment by applicable to notices filed after third calendar month beginning after , see , set out as a note under .

Effective Date of 1972 Amendment

Pub. L. 92–603, title II, § 257(b)86 Stat. 1447

“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 [] 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.”
, , , provided that:

Effective Date of 1968 Amendment

Pub. L. 90–248section 145(e) of Pub. L. 90–248section 1395p of this titleAmendment by effective , see , set out as a note under .

Coverage Period; Termination Dates

Pub. L. 90–97, § 3(a)81 Stat. 249

42 U.S.C. 1395q(b)(1)42 U.S.C. 1395j42 U.S.C. 1395q(a)“In the case of any individual who, pursuant to section 1838(b)(1) of the Social Security Act [], terminates his enrollment in the insurance program established under part B of title XVIII of such Act [ et seq.], his coverage period (as defined in section 1838(a) of such Act) []—
“(1)
shall terminate at the close of , if he filed his notice of termination before , or
“(2)
shall terminate at the close of , if he filed his notice of termination after , and before .
42 U.S.C. 1395p(b)(2)42 U.S.C. 1395q(a)(2)(E)42 U.S.C. 1395p(b)(2)42 U.S.C. 1395p(e)An individual whose coverage period terminated pursuant to paragraph (1) at the close of , may, notwithstanding section 1837(b)(2) of such Act [], enroll in such program before , and for purposes of sections 1838(a)(2)(E) [] and 1837(b)(2) of such Act [] such enrollment shall be deemed an enrollment under section 1837(e) of such Act [] and a second enrollment under such part.”
, , , provided that:

Extension of 1967 General Enrollment Period Through

section 1395p(e) of this titlesection 1 of Pub. L. 90–9781 Stat. 249section 1395p of this titleExtension of the general enrollment period under through , see , , , set out as a note under .

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

Pub. L. 89–384, § 3(d)80 Stat. 105

42 U.S.C. 1395o42 U.S.C. 1395p42 U.S.C. 1395q(a)(2)(D)“In the case of an individual who first satisfies paragraphs (1) and (2) of section 1836 of the Social Security Act [] in March, 1966, and who enrolls pursuant to subsection (d) of section 1837 of such Act [] in May 1966, his coverage period shall, notwithstanding section 1838(a)(2)(D) of such Act [], begin on .”
, , , provided that:

Commencement of Coverage Period of Certain Enrollees

section 102(b) of Pub. L. 89–97section 1395p of this titleCommencement of coverage period upon enrollment before of eligible individuals failing for good cause to enroll before , see , set out as a note under .