--- kind: "section" citation: "42 U.S.C. § 1395o" title: "42" title_heading: "The Public Health and Welfare" number: "1395o" heading: "Eligible individuals" release: "119-102" date: "2026-07-12" url: "https://uscodex.org/usc/42/1395o" units: - "Chapter 7 — Social Security" - "Subchapter XVIII — Health Insurance for Aged and Disabled" - "Part B — Supplementary Medical Insurance Benefits for Aged and Disabled" --- # §1395o. Eligible individuals - (a) **In general—** Every individual who— - (1) is entitled to [hospital](/usc/42/300s–3.md?p=1) insurance benefits under part A, or - (2) has attained age 65 and is a resident of the [United States](/usc/42/1301.md?p=a-2), and is either (A) a citizen or (B) an alien lawfully admitted for permanent residence who has resided in the [United States](/usc/42/1301.md?p=a-2) continuously during the 5 years immediately preceding the month in which he applies for enrollment under this part, is eligible to enroll in the insurance program established by this part. - (b) **Individuals eligible for immunosuppressive drug coverage—** - (1) **In general—** Except as provided under [paragraph (2)](#b-2), every individual whose entitlement to insurance benefits under part A ends (whether before, on, or after January 1, 2023) by reason of [section 426–1(b)(2) of this title](/usc/42/426–1.md?p=b-2) is eligible to enroll or to be deemed to have enrolled in the medical insurance program established by this part solely for purposes of coverage of immunosuppressive [drugs](/usc/42/11851.md?p=4) in accordance with [section 1395p(n) of this title](/usc/42/1395p.md?p=n). - (2) **Exception if other coverage is available—** - (A) **In general—** An individual described in [paragraph (1)](#b-1) shall not be eligible for enrollment in the program for purposes of coverage described in such paragraph with respect to any period in which the individual, as determined in accordance with [subparagraph (B)](#b-2-B)— - (i) is enrolled in a [group health plan](/usc/42/1397jj.md?p=c-3) or group or individual [health insurance coverage](/usc/42/1397jj.md?p=c-3), as such terms are defined in [section 300gg–91 of this title](/usc/42/300gg–91.md); - (ii) is enrolled for coverage under the TRICARE for Life program under [section 1086(d) of title 10](/usc/10/1086.md?p=d); - (iii) is enrolled under a [State](/usc/42/619.md?p=5) plan (or waiver of such plan) under subchapter XIX and is eligible to receive benefits for immunosuppressive [drugs](/usc/42/11851.md?p=4) described in this subsection under such plan (or such waiver); - (iv) is enrolled under a [State child health plan](/usc/42/1397jj.md?p=c-7) (or waiver of such plan) under subchapter XXI and is eligible to receive benefits for such [drugs](/usc/42/11851.md?p=4) under such plan (or such waiver); or - (v) - (I) is enrolled in the patient enrollment system of the Department of Veterans Affairs established and operated under [section 1705 of title 38](/usc/38/1705.md); - (II) is not required to enroll under [section 1705](/usc/42/1705.md) of such title to receive immunosuppressive [drugs](/usc/42/11851.md?p=4) described in this subsection; or - (III) is otherwise eligible under a provision of [title 38](/usc/38.md), other than section 1710 of such title to receive immunosuppressive [drugs](/usc/42/11851.md?p=4) described in this subsection. - (B) **Eligibility determinations—** - (i) **In general—** The [Secretary](/usc/42/1301.md?p=a-6), in coordination with the Commissioner of [Social](/usc/42/1397j.md?p=20) Security, shall establish a process for determining whether an individual described in [paragraph (1)](#b-1) who is to be enrolled or deemed to be enrolled in the medical insurance program described in such paragraph meets the requirements for such enrollment under this subsection, [including](/usc/42/1301.md?p=b) the requirement that the individual not be enrolled in other coverage as described in [subparagraph (A)](#b-2-A). - (ii) **Attestation regarding other coverage—** The process established under [clause (i)](#b-2-B-i) shall include, at a minimum, a requirement that— - (I) the individual provide to the Commissioner an attestation that the individual is not enrolled and does not expect to enroll in such other coverage; and - (II) the individual notify the Commissioner within 60 days of enrollment in such other coverage. ## Source credit (Aug. 14, 1935, ch. 531, title XVIII, § 1836, as added Pub. L. 89–97, title I, § 102(a), July 30, 1965, 79 Stat. 304; amended Pub. L. 92–603, title II, § 201(c)(1), Oct. 30, 1972, 86 Stat. 1372; Pub. L. 116–260, div. CC, title IV, § 402(a)(2)(A), Dec. 27, 2020, 134 Stat. 2998.) ## Notes ### Editorial Notes ### Amendments 2020—Pub. L. 116–260 designated existing provisions as subsec. (a), inserted heading, and added subsec. (b). 1972—Pub. L. 92–603 designed former par. (2)(B) as par. (1), former par. (1) as introductory clause in par. (2), and former pars. (2)(A)(i) and (ii) as pars. (2)(A) and (B), and struck out “(A)” after “(2)”. ### Statutory Notes and Related Subsidiaries ### Persons Convicted of Subversive Activities Pub. L. 89–97, title I, § 104(b)(2), July 30, 1965, 79 Stat. 334, provided that: “An individual who has been convicted of any offense under (A) chapter 37 [section 792 et seq. of Title 18, Crimes and Criminal Procedure] (relating to espionage and censorship), chapter 105 [section 2151 et seq. of Title 18] (relating to sabotage), or chapter 115 [section 2381 et seq. of Title 18] (relating to treason, sedition, and subversive activities) of title 18 of the United States Code, or (B) section 4, 112, or 113 of the Internal Security Act of 1950, as amended [section 783, 822, or 823 of Title 50, War and National Defense], may not enroll under part B of title XVIII of the Social Security Act [42 U.S.C. 1395j et seq.].”