Fabio
76b8ec33a7
Ingested titles 12–51 and 54 from OLRC USLM XML @119-100 (the whole Code now, uniform edition; Title 53 is reserved/empty). LegalText 11,221 -> 59,740; repo total 105,704 records. Deterministic (byte-identical rerun, verified on Title 42's 8,356 sections); make check green. make legal-us-code default now covers every title. Co-Authored-By: Claude Opus 4.8 <noreply@anthropic.com>
54 lines
2.9 KiB
Markdown
54 lines
2.9 KiB
Markdown
---
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type: "LegalText"
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title: "42 U.S.C. § 1395w–103"
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description: "Access to a choice of qualified prescription drug coverage"
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jurisdiction: "us"
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corpus: "united_states_code"
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kind: "code_section"
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title_number: 42
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title_name: "THE PUBLIC HEALTH AND WELFARE"
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chapter_number: "7"
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chapter_name: "SOCIAL SECURITY"
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section: "1395w–103"
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citation: "42 U.S.C. § 1395w–103"
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status: "current"
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release_point: "119-100"
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release_date: "2026-06-26"
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source: "official"
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source_url: "https://uscode.house.gov/download/releasepoints/us/pl/119/100/xml_usc42@119-100.zip"
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source_identifier: "/us/usc/t42/s1395w–103"
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source_file: "data/legal/raw/us/code/title-42/usc42.xml"
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source_hash: "669debe59775ad2c9843cdea0d87db39413fc1e816712498c628efa9c5a773aa"
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raw_snapshot_hash: "644321055a08eb1f260a6a3e31ac157fa024756abf612a9fd6857e7e400cf24e"
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text_hash: "49baa4bc37b2c3855cd2114639b13d4ac342f520ba229881ec5b51d5fe3c13c6"
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retrieved_at: "2026-07-04"
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confidence: "official"
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tags: ["legal", "us-code"]
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---
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# 42 U.S.C. § 1395w–103 - Access to a choice of qualified prescription drug coverage
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## Text
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(a) Assuring access to a choice of coverage (1) Choice of at least two plans in each area The Secretary shall ensure that each part D eligible individual has available, consistent with paragraph (2), a choice of enrollment in at least 2 qualifying plans (as defined in paragraph (3)) in the area in which the individual resides, at least one of which is a prescription drug plan. In any such case in which such plans are not available, the part D eligible individual shall be given the opportunity to enroll in a fallback prescription drug plan.
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(2) Requirement for different plan sponsors The requirement in paragraph (1) is not satisfied with respect to an area if only one entity offers all the qualifying plans in the area.
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(3) Qualifying plan defined For purposes of this section, the term “qualifying plan” means—
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(A) a prescription drug plan; or
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(B) an MA–PD plan described in section 1395w–21(a)(2)(A)(i) of this title that provides—
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(i) basic prescription drug coverage; or
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(ii) qualified prescription drug coverage that provides supplemental prescription drug coverage so long as there is no MA monthly supplemental beneficiary premium applied under the plan, due to the application of a credit against such premium of a rebate under section 1395w–24(b)(1)(C) of this title.
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(b) Flexibility in risk assumed and application of fallback plan In order to ensure access pursuant to subsection (a) in an area—
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(1) the Secretary may approve limited risk plans under section 1395w–111(f) of this title for the area; and
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(2) only if such access is still not provided in the area after applying paragraph (1), the Secretary shall provide for the offering of a fallback prescription drug plan for that area under section 1395w–111(g) of this title.
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(Aug. 14, 1935, ch. 531, title XVIII, § 1860D–3, as added Pub. L. 108–173, title I, § 101(a)(2), Dec. 8, 2003, 117 Stat. 2081.)
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