Sec. 7. Medicare coverage of fertility treatment
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Section 1861(s)(2) of the Social Security Act ( 42 U.S.C. 1395x(s)(2) ) is amended— in subparagraph (JJ), by inserting and after the semicolon at the end; and by adding at the end the following new subparagraph: fertility treatment (as defined in section 2799A–11(b) of the Public Health Service Act); . Section 1833(a)(1) of the Social Security Act ( 42 U.S.C. 1395l(a)(1) ) is amended— by striking and before
(HH); and by inserting before the semicolon at the end the following: , and
(II)with respect to fertility treatment (as described in section 1861(s)(2)(KK)), the amount paid shall be equal to 100 percent of the lesser of the actual charge for the treatment or the amount determined under the payment basis determined under section 1848 . The first sentence of section 1833(b) of the Social Security Act ( 42 U.S.C. 1395l(b) ) is amended— by striking , and
(13)and inserting
(13); and by striking 1861(n).. and inserting 1861(n), and
(14)such deductible shall not apply with respect to fertility treatment (as described in section 1861(s)(2)(KK)). . Section 1848(j)(3) of the Social Security Act ( 42 U.S.C. 1395w–4(j)(3) ) is amended by inserting (2)(KK), after risk assessment), . Section 1862(a)(1)(A) of the Social Security Act ( 42 U.S.C. 1395y(a)(1)(A) ) is amended— by striking or additional and inserting , additional ; and by inserting , or fertility treatment (as described in section 1861(s)(2)(KK)) after 1861(ddd)(1)) . The amendments made by this section shall apply to services furnished on or after January 1, 2026.
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- 42 USC 1395w–4(j)(3)
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Sec. 7
Medicare coverage of fertility treatment
Cite42 USC 1395w–4(j)(3)
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