Expanding Health Care Options for Early Retirees Act

II 116TH CONGRESS 1ST SESSION S. 2552 To amend title XVIII of the Social Security Act to provide an option for first responders age 50 to 64 who are separated from service due to retirement or disability to buy into Medicare. IN THE SENATE OF THE UNITED STATES SEPTEMBER 26, 2019 Mr. BROWN 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 an option for first responders age 50 to 64 who are separated from service due to retirement or disability 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 ‘‘Expanding Health 4 Care Options for Early Retirees Act’’. 5 VerDate Sep 11 2014 00:46 Oct 04, 2019 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S2552.IS S2552 pamtmann on DSKBC07HB2PROD with BILLS 2 •S 2552 IS SEC. 2. MEDICARE BUY-IN OPTION FOR FIRST RESPOND- 1 ERS 50 TO 64 YEARS OF AGE WHO ARE SEPA- 2 RATED FROM SERVICE DUE TO RETIREMENT 3 OR DISABILITY. 4 (a) IN GENERAL.—Title XVIII of the Social Security 5 Act (42 U.S.C. 1395c et seq.) is amended by adding at 6 the end the following new section: 7 ‘‘MEDICARE BUY-IN OPTION FOR FIRST RESPONDERS 50 8 TO 64 YEARS OF AGE WHO ARE SEPARATED FROM 9 SERVICE DUE TO RETIREMENT OR DISABILITY 10 ‘‘SEC. 1899C. (a) OPTION.— 11 ‘‘(1) IN GENERAL.—Every individual who meets 12 the requirements described in paragraph (3) shall be 13 eligible to enroll under this section. 14 ‘‘(2) PART A, B, AND D BENEFITS.—An indi- 15 vidual enrolled under this section is entitled to the 16 same benefits (and shall receive the same protec- 17 tions) under this title as an individual who is enti- 18 tled to benefits under part A and enrolled under 19 parts B and D, including the ability to enroll in a 20 Medicare Advantage plan that provides qualified pre- 21 scription drug coverage (an MA–PD plan). 22 ‘‘(3) REQUIREMENTS FOR ELIGIBILITY.—The 23 requirements described in this paragraph are the fol- 24 lowing: 25 VerDate Sep 11 2014 00:46 Oct 04, 2019 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S2552.IS S2552 pamtmann on DSKBC07HB2PROD with BILLS 3 •S 2552 IS ‘‘(A) The individual is a resident of the 1 United States. 2 ‘‘(B) The individual is— 3 ‘‘(i) a citizen or national of the United 4 States; or 5 ‘‘(ii) an alien lawfully admitted for 6 permanent residence. 7 ‘‘(C) The individual is not otherwise enti- 8 tled to benefits under part A or eligible to en- 9 roll under part A or part B. 10 ‘‘(D) The individual has attained 50 years 11 of age but has not attained 65 years of age. 12 ‘‘(E) The individual is a qualified first re- 13 sponder (as defined in paragraph (4)(B)). 14 ‘‘(4) DEFINITIONS.—In this section: 15 ‘‘(A) FIRST RESPONDER.—The term ‘first 16 responder’ means— 17 ‘‘(i) a qualified law enforcement offi- 18 cer (as defined in section 926B(c) of title 19 18, United States Code); 20 ‘‘(ii) an employee described in clause 21 (i) of section 72(t)(10)(B) of the Internal 22 Revenue Code of 1986 who provides fire- 23 fighting services or emergency medical 24 services; or 25 VerDate Sep 11 2014 00:46 Oct 04, 2019 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S2552.IS S2552 pamtmann on DSKBC07HB2PROD with BILLS 4 •S 2552 IS ‘‘(iii) a Federal firefighter described 1 in section 8331(21) or 8401(14) of title 5, 2 United States Code. 3 ‘‘(B) QUALIFIED FIRST RESPONDER.—The 4 term ‘qualified first responder’ means a first re- 5 sponder who is separated from service due to 6 retirement or disability. 7 ‘‘(b) ENROLLMENT AND COVERAGE PERIODS.— 8 ‘‘(1) IN GENERAL.—The Secretary shall estab- 9 lish enrollment and coverage periods for individuals 10 who enroll under this section. 11 ‘‘(2) COORDINATION.—Such periods shall be es- 12 tablished in coordination with the enrollment and 13 coverage periods for plans offered under an Ex- 14 change established under title I of the Patient Pro- 15 tection and Affordable Care Act and plans under 16 parts C and D. If the Secretary determines appro- 17 priate, the Secretary may expand such enrollment 18 periods beyond the enrollment periods under such an 19 Exchange or under parts C and D. 20 ‘‘(3) BEGINNING OF COVERAGE AND SPECIAL 21 ENROLLMENT PERIODS.—The Secretary shall estab- 22 lish such periods so that coverage under this section 23 shall first begin on January 1 of the first year be- 24 ginning at least one year after the date of the enact- 25 VerDate Sep 11 2014 00:46 Oct 04, 2019 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S2552.IS S2552 pamtmann on DSKBC07HB2PROD with BILLS 5 •S 2552 IS ment of this section and shall include special enroll- 1 ment periods, in accordance with section 155.420 of 2 title 45 of the Code of Federal Regulations, that are 3 applicable to qualified health plans offered through 4 an Exchange. 5 ‘‘(c) PREMIUM.— 6 ‘‘(1) AMOUNT OF MONTHLY PREMIUMS.—The 7 Secretary shall (beginning for the first year that be- 8 gins more than 1 year after the date of enactment 9 of this section) determine a monthly premium for all 10 individuals enrolled under this section. Such monthly 11 premium shall be equal to 1⁄12 of the annual pre- 12 mium computed under paragraph (2)(B), which 13 shall apply with respect to coverage provided under 14 this section for any month in the succeeding year. 15 ‘‘(2) ANNUAL PREMIUM.— 16 ‘‘(A) COMBINED PER CAPITA AVERAGE FOR 17 ALL MEDICARE BENEFITS.—The Secretary shall 18 estimate the average, annual per capita amount 19 for benefits and administrative expenses that 20 will be payable under parts A, B, and D (in- 21 cluding, as applicable, under part C) in the year 22 for all individuals enrolled under this section. 23 ‘‘(B) ANNUAL PREMIUM.—The annual pre- 24 mium under this subsection for months in a 25 VerDate Sep 11 2014 00:46 Oct 04, 2019 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S2552.IS S2552 pamtmann on DSKBC07HB2PROD with BILLS 6 •S 2552 IS year is equal to the average, annual per capita 1 amount estimated under subparagraph (A) for 2 the year. 3 ‘‘(3) INCREASED PREMIUM FOR CERTAIN PART 4 C AND D PLANS.—Nothing in this section shall pre- 5 clude an individual from choosing a Medicare Advan- 6 tage plan or a prescription drug plan which requires 7 the individual to pay an additional amount (because 8 of supplemental benefits or because it is a more ex- 9 pensive plan). In such case the individual would be 10 responsible for the increased monthly premium. 11 ‘‘(d) PAYMENT OF PREMIUMS.— 12 ‘‘(1) IN GENERAL.—Premiums for enrollment 13 under this section shall be paid to the Secretary at 14 such times, and in such manner, as the Secretary 15 determines appropriate. 16 ‘‘(2) DEPOSIT.—Amounts collected by the Sec- 17 retary under this section shall be deposited in the 18 Federal Hospital Insurance Trust Fund and the 19 Federal Supplementary Medical Insurance Trust 20 Fund (including the Medicare Prescription Drug Ac- 21 count within such Trust Fund) in such proportion 22 as the Secretary determines appropriate. 23 ‘‘(e) NOT ELIGIBLE FOR MEDICARE COST-SHARING 24 ASSISTANCE.—An individual enrolled under this section 25 VerDate Sep 11 2014 00:46 Oct 04, 2019 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S2552.IS S2552 pamtmann on DSKBC07HB2PROD with BILLS 7 •S 2552 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) TREATMENT IN RELATION TO THE AFFORDABLE 4 CARE ACT.— 5 ‘‘(1) SATISFACTION OF INDIVIDUAL MAN- 6 DATE.—For purposes of applying section 5000A of 7 the Internal Revenue Code of 1986, the coverage 8 provided under this section constitutes minimum es- 9 sential coverage under subsection (f)(1)(A)(i) of 10 such section 5000A. 11 ‘‘(2) ELIGIBILITY FOR PREMIUM ASSISTANCE.— 12 Coverage provided under this section— 13 ‘‘(A) shall be treated as coverage under a 14 qualified health plan in the individual market 15 enrolled in through the Exchange where the in- 16 dividual resides for all purposes of section 36B 17 of the Internal Revenue Code of 1986 other 18 than subsection (c)(2)(B) thereof; and 19 ‘‘(B) shall not be treated as eligibility for 20 other minimum essential coverage for purposes 21 of subsection (c)(2)(B) of such section 36B. 22 The Secretary shall determine the applicable second 23 lowest cost silver plan which shall apply to coverage 24 VerDate Sep 11 2014 00:46 Oct 04, 2019 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S2552.IS S2552 pamtmann on DSKBC07HB2PROD with BILLS 8 •S 2552 IS under this section for purposes of section 36B of 1 such Code. 2 ‘‘(3) ELIGIBILITY FOR COST-SHARING SUB- 3 SIDIES.—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 eligible for enrollment under a 17 State plan under title XIX are prohibited from cov- 18 erage under this title pursuant to enrollment under 19 this section. The preceding sentence shall not apply 20 to Medicaid beneficiaries whose Medicaid coverage or 21 eligibility does not meet the definition of minimum 22 essential coverage under a government-sponsored 23 program under section 1.5000A–2 of title 26, Code 24 of Federal Regulations (or any successor regulation). 25 VerDate Sep 11 2014 00:46 Oct 04, 2019 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S2552.IS S2552 pamtmann on DSKBC07HB2PROD with BILLS 9 •S 2552 IS ‘‘(5) COORDINATION WITH MARKET REFORMS, 1 ETC.—Notwithstanding Treasury Notice 2015–17, 2 no provision of law shall prevent an employer from 3 maintaining an arrangement under which the em- 4 ployer pays or reimburses any portion of the pre- 5 miums for coverage under this section for retired 6 employees of the employer, or prevent such payment 7 or reimbursement from being excluded from the 8 gross income of the individual enrolled in such cov- 9 erage for purposes of the Internal Revenue Code of 10 1986. 11 ‘‘(g) GUARANTEED ISSUE OF MEDIGAP POLICIES 12 UPON FIRST ENROLLMENT AND EACH SUBSEQUENT EN- 13 ROLLMENT.—In the case of an individual who enrolls 14 under this section (including an individual who was pre- 15 viously enrolled under this section), paragraphs (2)(A), 16 (2)(D), (3)(B)(ii), and (3)(B)(vi) of section 1882(s)— 17 ‘‘(1) shall be applied by substituting ‘50’ for 18 ‘65’; 19 ‘‘(2) if the individual was enrolled under this 20 section and subsequently disenrolls, shall apply each 21 time the individual subsequently reenrolls under this 22 section as if the individual had attained 50 years of 23 age on the date of such reenrollment (and as if the 24 VerDate Sep 11 2014 00:46 Oct 04, 2019 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S2552.IS S2552 pamtmann on DSKBC07HB2PROD with BILLS 10 •S 2552 IS individual had never previously enrolled in a Medi- 1 care supplemental policy); and 2 ‘‘(3) shall be applied as if this section had not 3 been enacted (and as if the individual had never pre- 4 viously enrolled in a Medicare supplemental policy) 5 when the individual attains 65 years of age. 6 ‘‘(h) OVERSIGHT.—There is established an advisory 7 committee to be known as the ‘Medicare Buy In Oversight 8 Board’ to monitor and oversee the implementation of this 9 section, including the experience of the individuals enroll- 10 ing under this section. The Medicare Buy In Oversight 11 Board shall have members that include representatives of 12 insurers, actuaries, consumer advocacy organizations, and 13 individuals representing the first responder community, 14 and shall make periodic recommendations for the con- 15 tinual improvement of the implementation of this section 16 as well as the relationship of enrollment under this section 17 to other health care programs. 18 ‘‘(i) OUTREACH AND ENROLLMENT.— 19 ‘‘(1) IN GENERAL.—During the period that be- 20 gins on January 1, 2020, and ends on December 31, 21 2022, the Secretary shall award grants to eligible 22 entities for the following purposes: 23 ‘‘(A) OUTREACH AND ENROLLMENT.—To 24 carry out outreach, public education activities, 25 VerDate Sep 11 2014 00:46 Oct 04, 2019 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S2552.IS S2552 pamtmann on DSKBC07HB2PROD with BILLS 11 •S 2552 IS and enrollment activities to raise awareness of 1 the availability of, and encourage, enrollment 2 under this section. 3 ‘‘(B) ASSISTING INDIVIDUALS’ TRANSITION 4 UNDER THIS SECTION.—To provide assistance 5 to individuals to enroll under this section. 6 ‘‘(C) RAISING AWARENESS OF PREMIUM 7 ASSISTANCE AND COST-SHARING REDUC- 8 TIONS.—To distribute fair and impartial infor- 9 mation concerning enrollment under this section 10 and the availability of premium assistance tax 11 credits under section 36B of the Internal Rev- 12 enue Code of 1986 and cost-sharing reductions 13 under section 1402 of the Patient Protection 14 and Affordable Care Act, and to assist eligible 15 individuals in applying for such tax credits and 16 cost-sharing reductions. 17 ‘‘(2) ELIGIBLE ENTITIES.— 18 ‘‘(A) IN GENERAL.—In this subsection, the 19 term ‘eligible entity’ means— 20 ‘‘(i) a State; 21 ‘‘(ii) a nonprofit community-based or- 22 ganization; or 23 ‘‘(iii) a nonprofit first responder orga- 24 nization. 25 VerDate Sep 11 2014 00:46 Oct 04, 2019 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S2552.IS S2552 pamtmann on DSKBC07HB2PROD with BILLS 12 •S 2552 IS ‘‘(B) ENROLLMENT AGENTS.—Such term 1 includes a licensed independent insurance agent 2 or broker that has an arrangement with a 3 State, nonprofit community-based organization, 4 or nonprofit first responder organization to en- 5 roll eligible individuals under this section. 6 ‘‘(C) EXCLUSIONS.—Such term does not 7 include an entity that— 8 ‘‘(i) is a health insurance issuer; or 9 ‘‘(ii) receives any consideration, either 10 directly or indirectly, from any health in- 11 surance issuer in connection with the en- 12 rollment of any individuals under this sec- 13 tion. 14 ‘‘(3) PRIORITY.—In awarding grants under this 15 subsection, the Secretary shall give priority to 16 awarding grants to States or eligible entities in 17 States that have geographic [Text truncated for display. 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