U.S. Code » Title 42 » Chapter CHAPTER 7— SOCIAL SECURITY › Subchapter SUBCHAPTER XVIII— HEALTH INSURANCE FOR AGED AND DISABLED › Part Part B— Supplementary Medical Insurance Benefits for Aged and Disabled

42 U.S.C. § 1395o

Eligible individuals

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(a) In generalEvery individual who—(1) is entitled to hospital insurance benefits under part A, or(2) has attained age 65 and 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 part,is eligible to enroll in the insurance program established by this part.(b) Individuals eligible for immunosuppressive drug coverage(1) In general

Except as provided under paragraph (2), every individual whose entitlement to insurance benefits under part A ends (whether before, on, or after January 1, 2023) by reason of section 426–1(b)(2) of this title is eligible to enroll or to be deemed to have enrolled in the medical insurance program established by this part solely for purposes of coverage of immunosuppressive drugs in accordance with section 1395p(n) of this title.

(2) Exception if other coverage is available(A) In generalAn individual described in paragraph (1) shall not be eligible for enrollment in the program for purposes of coverage described in such paragraph with respect to any period in which the individual, as determined in accordance with subparagraph (B)—(i) is enrolled in a group health plan or group or individual health insurance coverage, as such terms are defined in section 300gg–91 of this title;(ii) is enrolled for coverage under the TRICARE for Life program under section 1086(d) of title 10;(iii) is enrolled under a State plan (or waiver of such plan) under subchapter XIX and is eligible to receive benefits for immunosuppressive drugs described in this subsection under such plan (or such waiver);(iv) is enrolled under a State child health plan (or waiver of such plan) under subchapter XXI and is eligible to receive benefits for such drugs under such plan (or such waiver); or(v)(I) is enrolled in the patient enrollment system of the Department of Veterans Affairs established and operated under section 1705 of title 38;(II) is not required to enroll under section 1705 of such title to receive immunosuppressive drugs described in this subsection; or(III) is otherwise eligible under a provision of title 38, other than section 1710 of such title to receive immunosuppressive drugs described in this subsection.(B) Eligibility determinations(i) In general

The Secretary, in coordination with the Commissioner of Social Security, shall establish a process for determining whether an individual described in paragraph (1) who is to be enrolled or deemed to be enrolled in the medical insurance program described in such paragraph meets the requirements for such enrollment under this subsection, including the requirement that the individual not be enrolled in other coverage as described in subparagraph (A).

(ii) Attestation regarding other coverageThe process established under clause (i) shall include, at a minimum, a requirement that—(I) the individual provide to the Commissioner an attestation that the individual is not enrolled and does not expect to enroll in such other coverage; and(II) the individual notify the Commissioner within 60 days of enrollment in such other coverage.(Aug. 14, 1935, ch. 531, title XVIII, § 1836, as added Pub. L. 89–97, title I, § 102(a), July 30, 1965, 79 Stat. 304; amended Pub. L. 92–603, title II, § 201(c)(1), Oct. 30, 1972, 86 Stat. 1372; Pub. L. 116–260, div. CC, title IV, § 402(a)(2)(A), Dec. 27, 2020, 134 Stat. 2998.)Editorial NotesAmendments

2020—Pub. L. 116–260 designated existing provisions as subsec. (a), inserted heading, and added subsec. (b).

1972—Pub. L. 92–603 designed former par. (2)(B) as par. (1), former par. (1) as introductory clause in par. (2), and former pars. (2)(A)(i) and (ii) as pars. (2)(A) and (B), and struck out “(A)” after “(2)”.

Statutory Notes and Related SubsidiariesPersons Convicted of Subversive Activities

Pub. L. 89–97, title I, § 104(b)(2), July 30, 1965, 79 Stat. 334, provided that: “An individual who has been convicted of any offense under (A) chapter 37 [section 792 et seq. of Title 18, Crimes and Criminal Procedure] (relating to espionage and censorship), chapter 105 [section 2151 et seq. of Title 18] (relating to sabotage), or chapter 115 [section 2381 et seq. of Title 18] (relating to treason, sedition, and subversive activities) of title 18 of the United States Code, or (B) section 4, 112, or 113 of the Internal Security Act of 1950, as amended [section 783, 822, or 823 of Title 50, War and National Defense], may not enroll under part B of title XVIII of the Social Security Act [42 U.S.C. 1395j et seq.].”

Notes of Decisions
Cited in 31 cases (1 in the last 5 years), 1972–2025 · leading case: Mathews v. Diaz, 426 U.S. 67 (1976).
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Mathews v. Diaz, 426 U.S. 67 (1976). · cites it 4× “Specifically, they attack 42 U. S. C. § 1395o (2) (1970 ed., Supp. IV), which grants eligibility to resident citi-zents who are 65 or older but denies eligibility to comparable aliens unless they have been admitted for permanent residence and also have resided in the United…”
Plyler v. Doe, 457 U.S. 202 (1982). “205 (b) (1981), and the Medicaid hospital insurance benefits for the aged and disabled program, 42 U. S. C. §1395o and 42 CFR §405.103 (a)(4) (1981).”
Diaz v. Weinberger, 361 F. Supp. 1 (S.D. Fla. 1973). · cites it 11× “” 42 U.S.C. § 1395o (1970). 2 . Judicial review of supplemental medical insurance entitlement determinations is governed by Section 1869 of the Social Security Act of 1935, as amended, which provides in pertinent part: “Any individual dissatisfied with any determination .”
United States v. Jeffrey Jay Rutgard, 116 F.3d 1270 (9th Cir. 1997). “42 U.S.C. § 1395o. As Medicare beneficiaries are 65 years of age or older, medical treatment of their eyes is a significant part of Medicare coverage.”
Hall v. Johnson, 599 F. Supp. 2d 1 (D.D.C. 2009). “42 U.S.C. § 1395o, which addresses Medicare Part B, states that “[ejvery individual who .”
In Re Zyprexa Prods. Liab. Litig., 451 F. Supp. 2d 458 (E.D.N.Y 2006). “§ 1395c; 42 U.S.C. § 1395o. From 1965 to 1980 Medicare was the primary payer of health care costs for most eligible individuals.”
Alfred H. Turecamo & Frances M. Turecamo v. Comm'r of Internal Revenue, 554 F.2d 564 (2d Cir. 1977). “Part B of the Medicare system, which provides coverage for supplementary medical services, constitutes a voluntary insurance program for which persons aged 65 and older, 42 U.S.C. § 1395o, are eligible to enroll to obtain benefits in return for the payment of monthly premiums,…”
Stockton East Water Dist. v. United States, 101 Fed. Cl. 352 (Fed. Cl. 2011). “1883 (citing 42 U.S.C. § 1395o(2) (1970)). The claimant, although a permanent resident, did not attempt to enroll because he was unable to meet the residence requirement.”
Barannikova v. Town of Greenwich, 643 A.2d 251 (Conn. 1994). “Third, as the commissioner correctly argues in the present case, the United States Supreme Court has applied rational basis review to a federal welfare law, 42 U.S.C. § 1395o (2) (1970 Ed., Sup. IV), that conditioned a resident alien’s eligibility for federal medicare benefits…”
Sta-Home Home Health Agency, Inc. v. Donna E. Shalala, Sec'y of U.S. Dep't of Health & Human Servs., 34 F.3d 305 (5th Cir. 1994). “Pursuant to the Social Security Act, Sta-Home is to be reimbursed only for “reasonable costs”, 42 U.S.C. § 1395o, a term defined, in part, as “the cost actually incurred”.”
Kurti v. Maricopa Cnty., 33 P.3d 499 (Ariz. Ct. App. 2001). “1883 (upholding 42 U.S.C. § 1395o (1970 ed., Supp. IV)). ¶ 13 The Supreme Court recognized that Congress has a legitimate basis for distinguishing among aliens because of its exclusive responsibility for regulating the relationship between the United States and aliens.”
Rehab. Ass'n of Virginia, Inc. v. Kozlowski, 42 F.3d 1444 (4th Cir. 1994). “Under Part B, individuals entitled to Part A benefits and certain others, see 42 U.S.C. § 1395o, may purchase supplementary insurance for hospital out-patient services, physician services, and other medical services not covered under Part A.”
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— 42 U.S.C. § 1395o(2) — 4 cases
Diaz v. Weinberger, 361 F. Supp. 1 (S.D. Fla. 1973). “” 42 U.S.C. § 1395o (1970). 2 . Judicial review of supplemental medical insurance entitlement determinations is governed by Section 1869 of the Social Security Act of 1935, as amended, which provides in pertinent part: “Any individual dissatisfied with any determination .”
Stockton East Water Dist. v. United States, 101 Fed. Cl. 352 (Fed. Cl. 2011). “1883 (citing 42 U.S.C. § 1395o(2) (1970)). The claimant, although a permanent resident, did not attempt to enroll because he was unable to meet the residence requirement.”
Lopez v. Bergland, 448 F. Supp. 1279 (N.D. Cal. 1978).
Wilson v. Edelman, 542 F.2d 1260 (7th Cir. 1976).
— 42 U.S.C. § 1395o(2)(A) — 1 case
Diaz v. Weinberger, 361 F. Supp. 1 (S.D. Fla. 1973). “” 42 U.S.C. § 1395o (1970). 2 . Judicial review of supplemental medical insurance entitlement determinations is governed by Section 1869 of the Social Security Act of 1935, as amended, which provides in pertinent part: “Any individual dissatisfied with any determination .”
— 42 U.S.C. § 1395o(2)(A)(ii) — 1 case
Diaz v. Weinberger, 361 F. Supp. 1 (S.D. Fla. 1973). “” 42 U.S.C. § 1395o (1970). 2 . Judicial review of supplemental medical insurance entitlement determinations is governed by Section 1869 of the Social Security Act of 1935, as amended, which provides in pertinent part: “Any individual dissatisfied with any determination .”
— 42 U.S.C. § 1395o(l) — 1 case
Toner v. Schweiker, 537 F. Supp. 846 (W.D.N.Y. 1982).
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