Sec. 423. New benefit structure under unified Medicare
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Part E of title XVIII of the Social Security Act, as added by section 251, is amended by adding at the end the following: Beginning with 2021, in the case of a Medicare enrollee, if the amount of the out-of-pocket cost-sharing of such enrollee for a calendar year equals or exceeds the catastrophic limit under subsection
(b)for that year— the enrollee shall not be responsible for additional out-of-pocket cost-sharing incurred during that year; and the Secretary shall establish procedures under which the Secretary shall, in appropriate part from the Part A Medicare FFS Account under section 1817 and the Part B Medicare FFS Account under section 1841— pay on behalf of the enrollee the amount of the additional out-of-pocket cost-sharing described in paragraph
(1)attributable to deductibles and coinsurance described in subsection (c)(1); and reimburse the enrollee the amount of the additional out-of-pocket cost-sharing described in paragraph
(1)attributable to deductibles and coinsurance described in subsection (c)(2). The amount of the catastrophic limit under this subsection for a year shall be the dollar amount in effect under section 223(c)(2)(A)(ii) of the Internal Revenue Code of 1986 for self-only coverage for taxable years beginning in such year. In this section, the term out-of-pocket cost-sharing means, with respect to an individual, the amount of costs incurred by the individual that are attributable to— deductibles and coinsurance imposed under part A or part B; and deductibles and coinsurance imposed under standard prescription drug coverage pursuant to section 1860D–2(b) or alternative prescription drug coverage pursuant to section 1860D–2(c) offered by a prescription drug plan. . Section 1852(a)(1)(B) of the Social Security Act ( 42 U.S.C. 1395w–22(a)(1)(B) ) is amended— in clause (i), by striking clause
(iii)and inserting clauses
(iii)and
(vi); and by adding at the end the following new clause: The provisions of section 1860E–21— shall apply to individuals enrolled under an MA–PD plan in the same manner as such provisions apply to Medicare enrollees under such section, except that in lieu of the application of subsection (a)(2) of such section the MA–PD plan shall establish procedures to provide for payment of any additional out-of-pocket cost-sharing described in subsection (a)(1) of such section incurred by individuals enrolled under the MA–PD plan; and as applied under subclause (I), may not be waived by application of this subparagraph. In applying subsection
(b)of section 1860E–21 pursuant to the previous sentence, an MA–PD plan may substitute a dollar amount that is less than the dollar amount specified under such subsection. . Section 1860D–2(c) of the Social Security Act ( 42 U.S.C. 1395w–102(c) ) is amended— in paragraph (2), by striking The deductible and inserting In the case of a prescription drug plan, the deductible ; and in paragraph (3), by striking The coverage provides and inserting In the case of a prescription drug plan, the coverage provides . Section 1860D–12(b) of the Social Security Act ( 42 U.S.C. 1395w–112(b) ) is amended by adding at the end the following new paragraph: Each contract entered into with a PDP sponsor under this part with respect to a prescription drug plan offered by such sponsor shall require that, with respect to each claim submitted for items or services furnished to an individual enrolled under the plan pursuant to the contract, the sponsor submits to the Secretary information on the amount of out-of-pocket cost-sharing (as defined in section 1860E–23(c)) applicable to such enrollee for such items or services. . Section 1813 of the Social Security Act ( 42 U.S.C. 1395e ) is amended— in subsection (a), by inserting Subject to subpart 2 of part E: before paragraph (1); and in subsection (b), by inserting Subject to subpart 2 of part E: before paragraph (1). Section 1833 of such Act ( 42 U.S.C. 1395l ) is amended— in subsection (a), in the matter preceding paragraph (1), by inserting and subpart 2 of part E after succeeding provisions of this section ; in subsection (b), in the first sentence, by striking Before applying and inserting Subject to subpart 2 of part E, before applying ; in subsection (c)(1), in the matter preceding subparagraph (A), by inserting subject to subpart 2 of part E, after this part, ; in subsection (f), by striking In establishing and inserting Subject to subpart 2 of part E, in establishing ; and in subsection (g)(1), by inserting and subpart 2 of part E and paragraphs
(4)and
(5). Section 1882(a)(2) of such Act is amended by striking No medicare and inserting Subject to section 1860E–24(c), no medicare .
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- 42 USC 1395w–22(a)(1)(B)
- 42 USC 1395w–102(c)
- 42 USC 1395w–112(b)
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Sec. 423
New benefit structure under unified Medicare
Cite42 USC 1395w–22(a)(1)(B)
Cite42 USC 1395w–102(c)
Cite42 USC 1395w–112(b)
Cites 5Cited by 0 across 0 sources