42 U.S.C. § 1395ss–1: Clarification

Summary

If a health plan pays for items or services that Medicare might cover, but a Medicare Advantage plan (including a private fee‑for‑service Medicare Advantage plan) does not pay because of deductibles, coinsurance, copayments, or other plan limits, that health plan must follow the Social Security Act’s rules for those extra payments.

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 Act (42 U.S.C. 1395ss(o)).

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.

§1395ss–1 Clarification

Summary

Title 42, §1395ss–1

Notes & Related Subsidiaries

Editorial Notes

References in Text

Citations & Metadata