WHAT THE LAW DOINCongress, in plain words

The law › Title 42, The Public Health and Welfare › Chapter 7

42 U.S.C. 1395w-114: Premium and cost-sharing subsidies for low-income individuals

Created in 2003 by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108-173). Changed by 5 later laws. 2 bills in this Congress would change it.

This Congress

  • H.R. 10874 Medicare Low Income Subsidy Equality Act of 2026 · introduced · would change (a)
  • H.R. 7853 PrEP Access and Coverage Act of 2026 · introduced · would change (a)

How it got here

2022

  • Pub. L. 117–169, §11404(1), substituted "certain individuals" for "individuals with income up to 150 percent of poverty line" in heading. Law text · (a)
  • Pub. L. 117–169, §11404(2), substituted "Individuals with certain low incomes" for "Individuals with income below 135 percent of poverty line" in heading and, in introductory provisions, inserted "(or, with respect to a plan year beginning on or after January 1, 2024, 150 percent)" … Law text · (a)
  • Pub. L. 117–169, §11201(e)(3)(A)(i), substituted "For a year preceding 2025, the continuation" for "The continuation". Law text · (a)
  • Pub. L. 117–169, §11401(b)(1), substituted "Subject to paragraph (6), in the case" for "In the case". Law text · (a)
  • Pub. L. 117–169, §11406(b)(1)(A), inserted at end "For plan year 2023 and subsequent plan years, the copayment amount applicable under the preceding sentence to a month's supply of a covered insulin product (as defined in section 1395w–102(b)(9)(C) of this title) dispensed t… Law text · (a)
  • Pub. L. 117–169, §11401(b)(1), substituted "Subject to paragraph (6), in the case" for "In the case". Law text · (a)
  • Pub. L. 117–169, §11201(e)(3)(A)(ii), substituted "1395w–102(b)(4)(A)(i)(I)(aa)" for "1395w–102(b)(4)(A)(i)(I)". Law text · (a)
  • Pub. L. 117–169, §11406(b)(1)(B), inserted before period at end "or under section 1395w–102(b)(9) of this title in the case of a covered insulin product (as defined in subparagraph (C) of such section)". Law text · (a)
  • Pub. L. 117–169, §11201(e)(3)(A)(iii), substituted "For a year preceding 2024, the elimination" for "The elimination". Law text · (a)
  • Pub. L. 117–169, §11404(3), substituted "Other low-income individuals" for "Other individuals with income below 150 percent of poverty line" in heading and "With respect to a plan year beginning before January 1, 2024, in the case of a subsidy" for "In the case of a subsidy" in intr… Law text · (a)
  • Pub. L. 117–169, §11406(b)(2)(A), substituted "paragraphs (8) and (9) of section 1395w–102(b)" for "section 1395w–102(b)(8)". Law text · (a)
  • Pub. L. 117–169, §11401(b)(2)(A), substituted "Subject to section 1395w–102(b)(8) of this title, a reduction" for "A reduction". Law text · (a)
  • Pub. L. 117–169, §11406(b)(2)(B), inserted at end "For plan year 2023, the amount of the coinsurance applicable under the preceding sentence to a month's supply of a covered insulin product (as defined in section 1395w–102(b)(9)(C) of this title) dispensed to the individual may n… Law text · (a)
  • Pub. L. 117–169, §11401(b)(2)(B), substituted "Subject to paragraph (6), the substitution" for "The substitution". Law text · (a)
  • Pub. L. 117–169, §11406(b)(2)(C), inserted at end "For plan year 2023, the amount of the copayment or coinsurance applicable under the preceding sentence to a month's supply of a covered insulin product (as defined in section 1395w–102(b)(9)(C) of this title) dispensed to the ind… Law text · (a)
  • Pub. L. 117–169, §11401(b)(2)(C), substituted "paragraph (6) of this subsection and subsection (c)" for "subsection (c)". Law text · (a)
  • Pub. L. 117–169, §11201(e)(3)(B), substituted "1395w–102(b)(4)(A)(i)(I)(aa)" for "1395w–102(b)(4)(A)(i)(I)". Law text · (a)
  • Pub. L. 117–169, §11401(b)(3), added par. (6). Law text · (a)

2020

  • Pub. L. 116–260 added subsec. (e) and redesignated former subsec. (e) as (f). (Consolidated Appropriations Act, 2021) Law text · (e), (f)

2010

  • Pub. L. 111–148, §3309, inserted "or, effective on a date specified by the Secretary (but in no case earlier than January 1, 2012), who would be such an institutionalized individual or couple, if the full-benefit dual eligible individual were not receiving services under a hom… (Patient Protection and Affordable Care Act) Law text · (a)
  • Pub. L. 111–148, §3304(a), added cl. (vi). (Patient Protection and Affordable Care Act) Law text · (a)
  • Pub. L. 111–148, §3303(a), added par. (5). (Patient Protection and Affordable Care Act) Law text · (a)
  • Pub. L. 111–152 substituted "and determined before the application of the monthly rebate computed under section 1395w–24(b)(1)(C)(i) of this title for that plan and year involved and, in the case of a qualifying plan, before the application of the increase under section 1395… (Health Care and Education Reconciliation Act of 2010) Law text · (b)
  • Pub. L. 111–148, §3302(a), inserted ", determined without regard to any reduction in such premium as a result of any beneficiary rebate under section 1854(b)(1)(C) or bonus payment under section 1395w–23(n) of this title" before period at end. (Patient Protection and Affordable Care Act) Law text · (b)
  • Pub. L. 111–148, §3305, added subsec. (d) and redesignated former subsec. (d) as (e). (Patient Protection and Affordable Care Act) Law text · (d), (e)

2008

  • Pub. L. 110–275, §114(a)(2), substituted "equal to 100 percent of the amount described in subsection (b)(1), but not to exceed the premium amount specified in subsection (b)(2)(B)." for "equal to— (Medicare Improvements for Patients and Providers Act of 2008) Law text · (a)
  • Pub. L. 110–275, §117(a), added subcl. (III). (Medicare Improvements for Patients and Providers Act of 2008) Law text · (a)
  • Pub. L. 110–275, §116(a)(1), inserted "and except that support and maintenance furnished in kind shall not be counted as income" after "section 1396a(r)(2) of this title". (Medicare Improvements for Patients and Providers Act of 2008) Law text · (a)
  • Pub. L. 110–275, §116(a)(2), (3), inserted "subject to the life insurance policy exclusion provided under subparagraph (G)" after "program" in introductory provisions. (Medicare Improvements for Patients and Providers Act of 2008) Law text · (a), (E)
  • Pub. L. 110–275, §116(a)(4), added subpar. (G). (Medicare Improvements for Patients and Providers Act of 2008) Law text · (a)

Text, outline and history from the official U.S. Code (2024 edition) on GovInfo, published by the Office of the Law Revision Counsel. Changes made after that edition appear under This Congress.