Sec. 1011. Medicare protection against high out-of-pocket expenditures for fee-for-service benefits and elimination of parts A and B deductibles
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/bill/116/s/1129/is/section-1011A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq.), as amended by section 1001, is amended by adding at the end the following new section: 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, if the amount of the out-of-pocket cost-sharing of such individual for a year (effective the year beginning January 1 of the year following the date of enactment of the Medicare for All Act of 2019 ) equals or exceeds $1,500, the individual shall not be responsible for additional out-of-pocket cost-sharing occurred during that year. Subject to paragraphs
(2)and (3), in this section, the term out-of-pocket cost-sharing means, with respect to an individual, the amount of the expenses incurred by the individual that are attributable to— coinsurance and copayments applicable under part A or B; or for items and services that would have otherwise been covered under part A or B but for the exhaustion of those benefits. Expenses incurred for items and services which are not included (or treated as being included) under part A or B shall not be considered incurred expenses for purposes of determining out-of-pocket cost-sharing under paragraph (1). 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). For purposes of paragraph (1), the Secretary shall consider expenses to be incurred by the individual without regard to whether the individual or another person, including a State program or other third-party coverage, has paid for such expenses. . Section 1813(b) of the Social Security Act ( 42 U.S.C. 1395e(b) ) is amended by adding at the end the following new paragraph: For each year (beginning January 1 of the year following the date of enactment of the Medicare for All Act of 2019 ), the inpatient hospital deductible for the year shall be $0. . Section 1833(b) of the Social Security Act ( 42 U.S.C. 1395l(b) ) is amended, in the first sentence— by striking and for a subsequent year and inserting for each of 2006 through the year that includes the date of enactment of the ; and Medicare for All Act of 2019 by inserting , and $0 for each year subsequent year after $1) .
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Sec. 1011
Medicare protection against high out-of-pocket expenditures for fee-for-service benefits and elimination of parts A and B deductibles
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