medicare cost-sharing

(3) The term “medicare cost-sharing” means (subject to section 1396a(n)(2) of this title ) the following costs incurred with respect to a qualified medicare beneficiary, without regard to whether the costs incurred were for items and services for which medical assistance is otherwise available under the plan: (A) (i) premiums under section 1395i–2 or 1395i–2a of this title , and (ii) premiums under section 1395r of this title , (B) Coinsurance under subchapter XVIII (including coinsurance described in section 1395e of this title ). (C) Deductibles established under subchapter XVIII (including those described in section 1395e of this title and section 1395l(b) of this title). (D) The difference between the amount that is paid under section 1395l(a) of this title and the amount that would be paid under such section if any reference to “80 percent” therein were deemed a reference to “100 percent”. Such term also may include, at the option of a State, premiums for enrollment of a qualified medicare beneficiary with an eligible organization under section 1395mm of this title .

Source

42 USC § 1396d(p)(3)


Scoping language

For purposes of this subchapter
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