Sec. 303. Improved benefit structure
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Title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq. ) is amended by adding at the end the following new sections: Notwithstanding any other provision of this title, for a year (beginning with 2018), in the case of an individual entitled to, or enrolled for, benefits under part A or enrolled in part B— the amount otherwise payable under part A and the total amount of expenses incurred by the individual during a year which would (except for this section) constitute incurred expenses for which benefits payable under section 1833(a) are determinable, shall be reduced by the amount of the unified deductible under subsection (b); and the individual shall be responsible for payment of such amount.
The amount of the unified deductible under this section shall be— for 2018, $650; or for a subsequent year, the amount specified in this subsection for the preceding year increased by the percentage increase in the medical care component of the consumer price index for all urban consumers (U.S. city average) as estimated by the Secretary for the 12-month period ending with the midpoint of the year involved. If any amount determined under paragraph
(1)is not a multiple of $1, such amount shall be rounded to the nearest multiple of $1. The unified deductible under this section for a year shall be applied as follows: With respect to items and services covered under part A, such unified deductible shall be applied on the basis of the amount that is payable for such items and services without regard to any copayments or coinsurance and before the application of any such copayments or coinsurance. With respect to items and services covered under part B, such unified deductible shall be applied on the basis of the total amount of the expenses incurred by the individual during a year which would, except for the application of the unified deductible, constitute incurred expenses for which items and services are payable under part B, without regard to any copayments or coinsurance and before the application of any such copayments or coinsurance. Except as provided in subparagraph (B), such unified deductible shall be applied with respect to all items and services covered under parts A and B and in lieu of the deductibles described in sections 1813(b) and 1833(b) or otherwise. Such unified deductible shall not be applied to preventive services and additional preventive services (as those terms are defined in section 1861(ddd)). The Secretary shall (beginning in 2017) announce (in a manner intended to provide notice to all interested parties) the unified deductible under this section and the annual out-of-pocket limit under section 1899D that will be applicable for the succeeding year. Notwithstanding any other provision of this title, in the case of an individual entitled to, or enrolled for, benefits under part A or enrolled in part B, after the application of the unified deductible under section 1899B and subject to the limit on annual out-of-pocket expenses under section 1899D, the amount otherwise payable under part A and the total amount of expenses incurred by the individual during a year (beginning with 2018) which would (except for this section) constitute incurred expenses for which benefits are payable under part B, shall be reduced by a coinsurance of 20 percent of such amount. The uniform coinsurance under this section for a year shall be applied as follows: With respect to items and services covered under part A, such uniform coinsurance shall be applied on the basis of the amount that is payable for such items and services. With respect to items and services covered under part B, such uniform coinsurance shall be applied on the basis of the total amount of the expenses incurred by the individual during a year which would, except for the application of the unified deductible, constitute incurred expenses from which items and services are payable under part B. Except as provided in subparagraph (B), such uniform coinsurance shall be applied with respect to all items and services covered under parts A and B and in lieu of any other copayments or coinsurance under such parts. Such uniform coinsurance shall not be applied to preventive services and additional preventive services (as those terms are defined in section 1861(ddd)). Notwithstanding any other provision of this title, in the case of an individual entitled to benefits under part A or enrolled in part B, if the amount of the out-of-pocket cost-sharing of such individual for a year (beginning with 2018) equals or exceeds the annual out-of-pocket limit under subsection
(b)for such year, there shall not be any additional reduction under section 1899C for the remainder of the year. The amount of the annual out-of-pocket limit under this subsection shall be— for 2018, $6,500; or for a subsequent year, the amount specified in this subsection for the preceding year increased by the percentage increase in the medical care component of the consumer price index for all urban consumers (U.S. city average) as estimated by the Secretary for the 12-month period ending with the midpoint of the year involved. If any amount determined under paragraph
(1)is not a multiple of $50, such amount shall be rounded to the nearest multiple of $50. Subject to paragraph (2), in this section, the term out-of-pocket cost-sharing means, with respect to an individual, the amount of expenses incurred by the individual that are attributable to deductibles, coinsurance, and copayments applicable under part A or B, without regard to whether the individual or another person, including a State program or other third-party coverage, has paid for such expenses. If an item or service is furnished to an individual under this title and is not furnished on an assignment-related basis, any additional expenses the individual incurs above the amount the individual would have incurred if the item or service was furnished on an assignment-related basis shall not be considered incurred expenses for purposes of determining out-of-pocket cost-sharing under paragraph (1). . Section 1852(a)(1)(B)(iii) of the Social Security Act ( 42 U.S.C. 1395w–22(a)(1)(B)(iii) ) is amended by adding at the end the following new sentence: For plan year 2018 and subsequent plan years, the preceding sentence shall be applied to take into account the application of sections 1899B, 1899C, and 1899D. . Section 1813 of the Social Security Act ( 42 U.S.C. 1395e ) is amended— in subsection (a), by inserting Subject to sections 1899B, 1899C, and 1899D: before paragraph (1); and in subsection (b), by inserting Subject to sections 1899B, 1899C, and 1899D: before paragraph (1). Section 1833 of the Social Security Act ( 42 U.S.C. 1395l ) is amended— in subsection (a), in the matter preceding paragraph (1), by inserting and sections 1899B, 1899C, and 1899D after succeeding provisions of this section ; in subsection (b), in the first sentence, by striking Before applying and inserting Subject to sections 1899B, 1899C, and 1899D, before applying ; in subsection (c)(1), in the matter preceding subparagraph (A), by inserting subject to sections 1899B, 1899C, and 1899D, after this part, ; in subsection (f), by striking In establishing and inserting Subject to sections 1899B, 1899C, and 1899D, in establishing ; and in subsection (g)(1), by inserting and sections 1899B, 1899C, and 1899D and paragraphs
(4)and
(5). Section 1905(p)(3) of the Social Security Act ( 42 U.S.C. 1396d(p)(3) ) is amended— in subparagraph (B), striking section 1813 and inserting sections 1813 and 1899C ; and in subparagraph (C), by striking and section 1833(b) and inserting , 1833(b), and 1899C .
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- 42 USC 1395w–22(a)(1)(B)(iii)
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Sec. 303
Improved benefit structure
Cite42 USC 1395w–22(a)(1)(B)(iii)
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