All four parts of Medicare are covered by Section 1557 of the Affordable Care Act. Medicare Parts A, C, and D have been covered since the law’s original implementation, and Medicare Part B was officially added through a 2024 rule change, with a compliance deadline of May 6, 2025. Any health care provider or insurer that receives payments through these programs is subject to Section 1557’s nondiscrimination requirements.
How Section 1557 Applies to Medicare
Section 1557 prohibits discrimination based on race, color, national origin, sex, age, or disability in any health program that receives federal financial assistance. The key question for Medicare has always been which parts of the program count as “federal financial assistance” rather than simple payment for services. HHS has identified the following Medicare-related entities as recipients of federal financial assistance:
- Part A: Hospitals and nursing homes that receive Medicare Part A payments
- Part B: Providers and suppliers of medical, preventive, and mental health services covered under Part B
- Part C: Medicare Advantage plans, including HMOs and PPOs
- Part D: Prescription drug plan sponsors and Medicare Advantage drug plans
This means the law reaches hospitals, physician practices, home health agencies, clinics, insurance issuers, and pharmacies, essentially any entity that participates in Medicare and receives payments from the federal government through these programs.
The 2024 Change That Added Part B
For years, HHS took the position that Medicare Part B payments did not qualify as federal financial assistance. The reasoning was that Part B functioned more like a payment-for-services arrangement than a grant or subsidy. This created an unusual gap: a hospital accepting Part A payments was covered, but a physician practice billing only Part B technically was not.
In May 2024, HHS finalized a rule reversing that position. The department concluded that Part B funds do meet the longstanding definition of federal financial assistance, bringing Part B providers under the same nondiscrimination obligations that already applied to the rest of Medicare. Providers whose only federal funding came through Part B were given a one-year grace period and must be in full compliance no later than May 6, 2025.
This change is significant because Part B covers a huge range of outpatient services: doctor visits, lab work, outpatient surgery, durable medical equipment, and mental health care. Many smaller practices and specialty providers that previously fell outside Section 1557’s reach are now covered.
What These Protections Require
Covered entities cannot refuse treatment or otherwise discriminate against patients based on race, color, national origin, sex, age, or disability. In practice, this translates into several concrete obligations that directly affect the patient experience.
For patients with limited English proficiency, providers must take reasonable steps to offer meaningful language access. That can include qualified interpreters (in person or by video) and written translations of important documents. Providers cannot rely on unqualified staff or low-quality video interpreting. They are also required to post notices of patients’ rights and taglines in the top 15 non-English languages spoken in their state, letting patients know language assistance is available.
For patients with disabilities, covered entities must make their programs accessible, including electronic tools like patient portals and mobile apps, unless doing so would create an undue financial or administrative burden. This means a Medicare Advantage plan’s website, a hospital’s online scheduling system, or a pharmacy’s digital tools all need to be usable by people with disabilities.
Who Enforces Section 1557 for Medicare
The Office for Civil Rights (OCR) within HHS is responsible for investigating complaints and enforcing compliance. If you believe a Medicare provider or plan has discriminated against you, you can file a complaint directly with OCR. The office has authority over any health program or activity funded by HHS, which covers the full scope of Medicare.
Enforcement can result in corrective action plans, voluntary resolution agreements, or, in more serious cases, referral to the Department of Justice. Providers found in violation risk losing their federal funding, which for most health care organizations means losing the ability to serve Medicare patients at all.
Medicare Advantage and Drug Plans
Private insurers that operate Medicare Advantage (Part C) or Part D prescription drug plans are covered because they receive federal payments to provide Medicare benefits. This matters because more than half of Medicare beneficiaries are now enrolled in Medicare Advantage plans. Section 1557 applies to these insurers’ coverage decisions, provider network design, customer communications, and benefit structures. A Medicare Advantage plan cannot, for example, design its benefits or provider network in a way that discriminates against enrollees based on any of the protected categories.
The same logic extends to insurers participating in the ACA Marketplaces who receive premium tax credits or cost-sharing reductions. If an insurer offers both Marketplace and Medicare products, its entire health program is subject to Section 1557.