; (B) in subsection (b), in the matter preceding paragraph (1), by inserting , subject to section 1860E–11(a) after individual who ; and (C) in subsection (c), in the matter preceding paragraph (1), by inserting , subject to section 1860E–11(a) after subsection (a) . (2) Section 226A Section 226A(a) of such Act ( 42 U.S.C. 426–1(a) ) is amended, in the matter preceding paragraph (1), by inserting and subject to section 1860E–11(a) after or title XVIII . (3) Section 1932 Section 1932(a)(2)(B) of the Social Security Act ( 42 U.S.C. 1396u–2(a)(2)(B) ) is amended by striking A State and inserting Except in the case of a State that has elected the maintenance of effort option described in section 1944(b)(2), a State . 423. New benefit structure under unified Medicare (a) In general Part E of title XVIII of the Social Security Act, as added by section 251, is amended by adding at the end the following: 2 Out-of-Pocket limit 1860E–21. Out-of-pocket limit (a) In general Beginning with 2021, in the case of a Medicare enrollee, if the amount of the out-of-pocket cost-sharing of such enrollee for a calendar year equals or exceeds the catastrophic limit under subsection (b) for that year— (1) the enrollee shall not be responsible for additional out-of-pocket cost-sharing incurred during that year; and (2) the Secretary shall establish procedures under which the Secretary shall, in appropriate part from the Part A Medicare FFS Account under section 1817 and the Part B Medicare FFS Account under section 1841— (A) pay on behalf of the enrollee the amount of the additional out-of-pocket cost-sharing described in paragraph (1) attributable to deductibles and coinsurance described in subsection (c)(1)