Title 42, The Public Health and WelfareRelease 119-73not60
§1395ss–1 Clarification
Title 42 › Chapter 7— SOCIAL SECURITY › Subchapter XVIII— HEALTH INSURANCE FOR AGED AND DISABLED › Part E— Miscellaneous Provisions › § 1395ss–1
Summary
If a private health plan pays for items or services that Medicare could pay for, but Medicare does not because a Medicare Advantage plan applies deductibles, coinsurance, copays, or other limits, the private plan must follow the Social Security Act’s rules about those payments.
Full Legal Text
Title 42, §1395ss–1
The Public Health and Welfare, Source: USLM XML via OLRC
Any health insurance policy that provides reimbursement for expenses incurred for items and services for which payment may be made under title XVIII of the Social Security Act [42 U.S.C. 1395 et seq.] but which are not reimbursable by reason of the applicability of deductibles, coinsurance, copayments or other limitations imposed by a Medicare Advantage plan (including a Medicare Advantage private fee-for-service plan) under part C of such title [42 U.S.C. 1395w–21 et seq.] shall comply with the requirements of section 1882(o) of the such 11 So in original. Act (42 U.S.C. 1395ss(o)).
Legislative History
Notes & Related Subsidiaries
Editorial Notes
References in Text
The Social Security Act, referred to in text, is act Aug. 14, 1935, ch. 531, 49 Stat. 620. Title XVIII of the Act is classified generally to this subchapter. Part C of title XVIII of the Act is classified to section 1395w–21 et seq. of this title. For complete classification of this Act to the Code, see section 1305 of this title and Tables. Codification Section was enacted as part of the Medicare Improvements for Patients and Providers Act of 2008, and not as part of the Social Security Act which comprises this chapter.
Reference
Citations & Metadata
Citation
42 U.S.C. § 1395ss–1
Title 42, The Public Health and Welfare
Last Updated
Apr 5, 2026
Release point: 119-73not60