Medicare at 50 Act

II 117TH CONGRESS 1ST SESSION S. 1279 To amend title XVIII of the Social Security Act to provide for an option for any citizen or permanent resident of the United States age 50 to 64 to buy into Medicare. IN THE SENATE OF THE UNITED STATES APRIL 21, 2021 Ms. STABENOW (for herself, Mr. BROWN, Ms. BALDWIN, Mr. BLUMENTHAL, Mr. CARDIN, Mr. CASEY, Ms. DUCKWORTH, Mr. DURBIN, Mrs. GILLI- BRAND, Ms. KLOBUCHAR, Mr. MARKEY, Mr. MERKLEY, Mr. PETERS, Mr. REED, Mrs. SHAHEEN, Ms. SMITH, Mr. VAN HOLLEN, and Mr. WHITE- HOUSE) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To amend title XVIII of the Social Security Act to provide for an option for any citizen or permanent resident of the United States age 50 to 64 to buy into Medicare. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Medicare at 50 Act’’. 4 VerDate Sep 11 2014 02:58 May 22, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1279.IS S1279 pbinns on DSKJLVW7X2PROD with BILLS 2 •S 1279 IS SEC. 2. MEDICARE BUY-IN OPTION FOR INDIVIDUALS 50 TO 1 64 YEARS OF AGE. 2 (a) IN GENERAL.—Title XVIII of the Social Security 3 Act (42 U.S.C. 1395c et seq.) is amended by adding at 4 the end the following new section: 5 ‘‘MEDICARE BUY-IN OPTION FOR INDIVIDUALS 50 TO 64 6 YEARS OF AGE 7 ‘‘SEC. 1899C. (a) OPTION.— 8 ‘‘(1) IN GENERAL.—Every individual who meets 9 the requirements described in paragraph (3) shall be 10 eligible to enroll under this section. 11 ‘‘(2) PART A, B, AND D BENEFITS AND PROTEC- 12 TIONS.—An individual enrolled under this section is 13 entitled to the same benefits (and shall receive the 14 same protections) under this title as an individual 15 who is entitled to benefits under part A and enrolled 16 under parts B and D, including the ability to enroll 17 in a Medicare Advantage plan that provides qualified 18 prescription drug coverage (an MA–PD plan) and 19 including access to the Medicare Beneficiary Om- 20 budsman under section 1808(c). 21 ‘‘(3) REQUIREMENTS FOR ELIGIBILITY.—The 22 requirements described in this paragraph are the fol- 23 lowing: 24 VerDate Sep 11 2014 02:58 May 22, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1279.IS S1279 pbinns on DSKJLVW7X2PROD with BILLS 3 •S 1279 IS ‘‘(A) AGE.—The individual has attained 50 1 years of age, but has not attained 65 years of 2 age. 3 ‘‘(B) MEDICARE ELIGIBILITY (BUT FOR 4 AGE).—The individual is not otherwise entitled 5 to benefits under part A or eligible to enroll 6 under part A or part B but would be eligible for 7 benefits under part A or part B if the indi- 8 vidual were 65 years of age. 9 ‘‘(b) ENROLLMENT AND COVERAGE PERIODS.— 10 ‘‘(1) IN GENERAL.—The Secretary shall estab- 11 lish enrollment and coverage periods for individuals 12 who enroll under this section. 13 ‘‘(2) COORDINATION.—Such periods shall be es- 14 tablished in coordination with the enrollment and 15 coverage periods for plans offered under an Ex- 16 change established under title I of the Patient Pro- 17 tection and Affordable Care Act and plans under 18 parts C and D. If the Secretary determines appro- 19 priate, the Secretary may expand such enrollment 20 periods beyond the enrollment periods under such an 21 Exchange or under parts C and D. 22 ‘‘(3) BEGINNING OF COVERAGE AND SPECIAL 23 ENROLLMENT PERIODS.—The Secretary shall estab- 24 lish such periods so that coverage under this section 25 VerDate Sep 11 2014 02:58 May 22, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1279.IS S1279 pbinns on DSKJLVW7X2PROD with BILLS 4 •S 1279 IS shall first begin on January 1 of the first year be- 1 ginning at least one year after the date of the enact- 2 ment of this section and shall include special enroll- 3 ment periods, in accordance with section 155.420 of 4 title 45 of the Code of Federal Regulations, that are 5 applicable to qualified health plans offered through 6 an Exchange. 7 ‘‘(c) PREMIUM.— 8 ‘‘(1) AMOUNT OF MONTHLY PREMIUMS.—The 9 Secretary shall (beginning for the first year that be- 10 gins more than 1 year after the date of the enact- 11 ment of this section), during September of the pre- 12 ceding year, determine a monthly premium for all 13 individuals enrolled under this section. Such monthly 14 premium shall be equal to 1⁄12 of the annual pre- 15 mium computed under paragraph (2)(B), which 16 shall apply with respect to coverage provided under 17 this section for any month in the succeeding year. 18 ‘‘(2) ANNUAL PREMIUM.— 19 ‘‘(A) COMBINED PER CAPITA AVERAGE FOR 20 ALL MEDICARE BENEFITS.—The Secretary shall 21 estimate the average, annual per capita amount 22 for benefits and administrative expenses that 23 will be payable under parts A, B, and D (in- 24 VerDate Sep 11 2014 02:58 May 22, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1279.IS S1279 pbinns on DSKJLVW7X2PROD with BILLS 5 •S 1279 IS cluding, as applicable, under part C) in the year 1 for all individuals enrolled under this section. 2 ‘‘(B) ANNUAL PREMIUM.—The annual pre- 3 mium under this subsection for months in a 4 year is equal to the average, annual per capita 5 amount estimated under subparagraph (A) for 6 the year. 7 ‘‘(3) INCREASED PREMIUM FOR CERTAIN PART 8 C AND D PLANS.—Nothing in this section shall pre- 9 clude an individual from choosing a Medicare Advan- 10 tage plan or a prescription drug plan that requires 11 the individual to pay an additional amount (because 12 of supplemental benefits or because it is a more ex- 13 pensive plan). In such case the individual would be 14 responsible for the increased monthly premium. 15 ‘‘(d) PAYMENT OF PREMIUMS.— 16 ‘‘(1) IN GENERAL.—Premiums for enrollment 17 under this section shall be paid to the Secretary at 18 such times, and in such manner, as the Secretary 19 determines appropriate. 20 ‘‘(2) DEPOSIT INTO MEDICARE BUY-IN TRUST 21 FUND.—Amounts collected by the Secretary under 22 this section shall be deposited in the Medicare Buy- 23 In Trust Fund established under paragraph (3). 24 ‘‘(3) MEDICARE BUY-IN TRUST FUND.— 25 VerDate Sep 11 2014 02:58 May 22, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1279.IS S1279 pbinns on DSKJLVW7X2PROD with BILLS 6 •S 1279 IS ‘‘(A) IN GENERAL.—There is hereby cre- 1 ated on the books of the Treasury of the United 2 States a trust fund to be known as the ‘Medi- 3 care Buy-In Trust Fund’ (in this paragraph re- 4 ferred to as the ‘Trust Fund’). The Trust Fund 5 shall consist of such gifts and bequests as may 6 be made as provided in section 201(i)(1) and 7 such amounts as may be deposited in, or appro- 8 priated to, such fund as provided in this title. 9 ‘‘(B) INCORPORATION OF PROVISIONS.— 10 Subsections (b) through (i) of section 1841 11 shall apply with respect to the Trust Fund and 12 this title in the same manner as they apply with 13 respect to the Federal Supplementary Medical 14 Insurance Trust Fund and part B, respectively, 15 except that in applying such section 1841, any 16 reference in such section to ‘this part’ shall be 17 construed to be a reference to this section and 18 any reference in section 1841(h) to section 19 1840(d) and in section 1841(i) to sections 20 1840(b)(1) and 1842(g) are deemed to be ref- 21 erences to comparable authority exercised under 22 this section. 23 ‘‘(e) NOT ELIGIBLE FOR MEDICARE COST-SHARING 24 ASSISTANCE.—An individual enrolled under this section 25 VerDate Sep 11 2014 02:58 May 22, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1279.IS S1279 pbinns on DSKJLVW7X2PROD with BILLS 7 •S 1279 IS shall not be treated as enrolled under any part of this title 1 for purposes of obtaining medical assistance for Medicare 2 cost-sharing or otherwise under title XIX. 3 ‘‘(f) ELIGIBILITY FOR FINANCIAL ASSISTANCE.— 4 ‘‘(1) IN GENERAL.—Individuals enrolled in cov- 5 erage under this section shall, from amounts trans- 6 ferred under paragraph (2), receive financial assist- 7 ance for such coverage that is substantially similar 8 to the assistance the individual would have received 9 if the individual were enrolled in a qualified health 10 plan through an Exchange. 11 ‘‘(2) TRANSFER OF FUNDS TO MEDICARE BUY- 12 IN TRUST FUND.— 13 ‘‘(A) IN GENERAL.—The Secretary shall 14 transfer to the Medicare Buy-In Trust Fund 15 under subsection (d)(3) for each plan year the 16 amount determined under paragraph (C) for 17 such year. 18 ‘‘(B) USE OF FUNDS.—The amounts 19 transferred to the Medicare Buy-In Trust Fund 20 under subparagraph (A) shall only be used to 21 reduce the premiums and cost-sharing for cov- 22 erage under this section of individuals enrolled 23 under such coverage who would be eligible for 24 cost-sharing reductions under section 1402 of 25 VerDate Sep 11 2014 02:58 May 22, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1279.IS S1279 pbinns on DSKJLVW7X2PROD with BILLS 8 •S 1279 IS the Patient Protection and Affordable Care Act 1 and premium assistance under section 36B of 2 the Internal Revenue Code of 1986 if such indi- 3 vidual were enrolled in a qualified health plan. 4 ‘‘(C) AMOUNT OF TRANSFER.— 5 ‘‘(i) IN GENERAL.—The amount de- 6 termined under this subparagraph for any 7 plan year is the aggregate amount the Sec- 8 retary determines is equal to 100 percent 9 of the premium tax credits under section 10 36B of the Internal Revenue Code of 11 1986, and 100 percent of the cost-sharing 12 reductions under section 1402 of the Pa- 13 tient Protection and Affordable Care Act, 14 that would have been provided for the plan 15 year to eligible individuals who meet speci- 16 fied income criteria and are enrolled for 17 such plan year in coverage provided 18 through enrollment under this section if 19 such individuals were enrolled for such 20 year in a qualified health plan through an 21 Exchange. 22 ‘‘(ii) SPECIFIC REQUIREMENTS.—The 23 Secretary shall make the determination 24 under clause (i) on a per enrollee basis and 25 VerDate Sep 11 2014 02:58 May 22, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S1279.IS S1279 pbinns on DSKJLVW7X2PROD with BILLS 9 •S 1279 IS shall take into account all relevant factors 1 necessary to determine the value of the 2 premium tax credits and cost-sharing re- 3 ductions that would have been provided to 4 eligible individuals described in section 5 1331 of the Patient Protection and Afford- 6 able Care Act, including the age and in- 7 come of the enrollee, geographic differences 8 in average spending for health care across 9 rating areas, the health status of the en- 10 rollee for purposes of determining risk ad- 11 justment payments and reinsurance pay- 12 ments that would have been made if the 13 enrollee had enrolled in a qualified health 14 plan through an Exchange, and whether 15 any reconciliation of the credit or cost- 16 sharing reductions would have occurred if 17 the enrollee had been so enrolled. This de- 18 termination shall take into consideration 19 the experience of other States with respect 20 to participation in an Exchange and such 21 credits and reductions provided to resi- 22 dents of the other States, with a special 23 focus on enrollees with income below 200 24 percent of poverty. 25 VerDate Sep 11 2014 02:58 May 22, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S1279.IS S1279 pbinns on DSKJLVW7X2PROD with BILLS 10 •S 1279 IS ‘‘(D) CERTIFICATION.— 1 ‘‘(i) IN GENERAL.—The Chief Actuary 2 of the Centers for Medicare & Medicaid 3 Services, in consultation with the Office of 4 Tax Analysis of the Department of the 5 Treasury, shall certify whether the method- 6 ology used to make determinations under 7 subparagraph (C), and such determina- 8 tions, meet the requirements of this para- 9 graph. 10 ‘‘(ii) CORRECTIONS.—The Secretary 11 shall adjust the payment to the Trust 12 Fund for any plan year to reflect any error 13 in the determinations under subparagraph 14 (C) for any preceding plan year. 15 ‘‘(iii) APPLICATION.—Coverage pro- 16 vided through enrollment under this part 17 and parts B and D pursuant to this sec- 18 tion shall be treated as coverage under a 19 qualified health plan in the silver level of 20 coverage in the individual market offered 21 through an Exchange and the Secretary 22 shall be treated as the issuer of such plan. 23 ‘‘(g) TREATMENT IN RELATION TO THE AFFORD- 24 ABLE CARE ACT.— 25 VerDate Sep 11 2014 02:58 May 22, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S1279.IS S1279 pbinns on DSKJLVW7X2PROD with BILLS 11 •S 1279 IS ‘‘(1) SATISFACTION OF INDIVIDUAL MAN- 1 DATE.—For purposes of applying section 5000A of 2 the Internal Revenue Code of 1986, the coverage 3 provided under this section constitutes minimum es- 4 sential coverage under subsection (f)(1)(A)(i) of 5 such section 5000A. 6 ‘‘(2) ELIGIBILITY FOR PREMIUM ASSISTANCE.— 7 Coverage provided under this section— 8 ‘‘(A) shall be treated as coverage under a 9 qualified health plan in the individual market 10 enrolled in through the Exchange where the in- 11 dividual resides for all purposes of section 36B 12 of the Internal Revenue Code of 1986 other 13 than subsection (c)(2)(B) thereof; and 14 ‘‘(B) shall not be treated as eligibility for 15 other minimum essential coverage for purposes 16 of subsection (c)(2)(B) of such section 36B. 17 The Secretary shall determine the applicable second 18 lowest cost silver plan which shall apply to coverage 19 under this section for purposes of determining the 20 premium assistance amount under section 36B(b)(2) 21 of such Code. Notwithstanding the preceding sen- 22 tences, in determining the applicable second lowest 23 cost silver plan with respect to any taxpayer under 24 section 36B(b)(3)(B) of such Code, coverage pro- 25 VerDate Sep 11 2014 02:58 May 22, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S1279.IS S1279 pbinns on DSKJLVW7X2PROD with BILLS 12 •S 1279 IS vided under this section shall not be taken into ac- 1 count as a silver plan of the individual market. 2 ‘‘(3) ELIGIBILITY FOR COST-SHARING REDUC- 3 TIONS.—For purposes of applying section 1402 of 4 the Patient Protection and Affordable Care Act (42 5 U.S.C. 18071)— 6 ‘‘(A) coverage provided under this section 7 shall be treated as coverage under a qualified 8 health plan in the silver level of coverage in the 9 individual market offered through an Exchange; 10 and 11 ‘‘(B) the Secretary shall be treated as the 12 issuer of such plan. 13 ‘‘(4) MEDICAID MANAGED CARE.—States are 14 prohibited from buying their Medicaid beneficiaries 15 ages 50 to 64 into Medicare under this section, and 16 individuals otherwise [Text truncated for display. 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