Bill Summary
The Medicare at 50 Act aims to amend the Social Security Act to allow individuals between the ages of 50 and 64 to buy into Medicare. It outlines eligibility requirements, enrollment and coverage periods, premium amounts, and financial assistance. The Act also establishes a Medicare Buy-In Trust Fund, prohibits Medicaid beneficiaries from enrolling, and creates an advisory committee for implementation. It includes provisions for outreach and enrollment, defines "eligible entity," and specifies the Secretary's authority to negotiate prescription drug prices.
Possible Impacts
1. Individuals between the ages of 50 and 64 will now have the option to buy into Medicare, providing them with greater access to healthcare coverage.
2. Those enrolled in coverage under this section will receive financial assistance, making Medicare more affordable for individuals in this age group.
3. The Act establishes an advisory committee to oversee implementation, ensuring that the needs and concerns of individuals between the ages of 50 and 64 are addressed during the implementation process.
[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 470 Introduced in Senate (IS)]
<DOC>
116th CONGRESS
1st Session
S. 470
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
February 13, 2019
Ms. Stabenow (for herself, Mr. Brown, Ms. Baldwin, Mr. Blumenthal, Mr.
Booker, Mr. Cardin, Ms. Duckworth, Mr. Durbin, Ms. Harris, Ms.
Klobuchar, Mr. Leahy, Mr. Markey, Mr. Merkley, Mr. Peters, Mr. Reed,
Mrs. Shaheen, Ms. Smith, Mr. Whitehouse, Mrs. Gillibrand, and Mr.
Heinrich) 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 Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Medicare at 50 Act''.
SEC. 2. MEDICARE BUY-IN OPTION FOR INDIVIDUALS 50 TO 64 YEARS OF AGE.
(a) In General.--Title XVIII of the Social Security Act (42 U.S.C.
1395c et seq.) is amended by adding at the end the following new
section:
``medicare buy-in option for individuals 50 to 64 years of age
``Sec. 1899C. (a) Option.--
``(1) In general.--Every individual who meets the
requirements described in paragraph (3) shall be eligible to
enroll under this section.
``(2) Part a, b, and d benefits and protections.--An
individual enrolled under this section is entitled to the same
benefits (and shall receive the same protections) under this
title as an individual who is entitled to benefits under part A
and enrolled under parts B and D, including the ability to
enroll in a Medicare Advantage plan that provides qualified
prescription drug coverage (an MA-PD plan) and including access
to the Medicare Beneficiary Ombudsman under section 1808(c).
``(3) Requirements for eligibility.--The requirements
described in this paragraph are the following:
``(A) Age.--The individual has attained 50 years of
age, but has not attained 65 years of age.
``(B) Medicare eligibility (but for age).--The
individual is not otherwise entitled to benefits under
part A or eligible to enroll under part A or part B but
would be eligible for benefits under part A or part B
if the individual were 65 years of age.
``(b) Enrollment and Coverage Periods.--
``(1) In general.--The Secretary shall establish enrollment
and coverage periods for individuals who enroll under this
section.
``(2) Coordination.--Such periods shall be established in
coordination with the enrollment and coverage periods for plans
offered under an Exchange established under title I of the
Patient Protection and Affordable Care Act and plans under
parts C and D. If the Secretary determines appropriate, the
Secretary may expand such enrollment periods beyond the
enrollment periods under such an Exchange or under parts C and
D.
``(3) Beginning of coverage and special enrollment
periods.--The Secretary shall establish such periods so that
coverage under this section shall first begin on January 1 of
the first year beginning at least one year after the date of
the enactment of this section and shall include special
enrollment periods, in accordance with section 155.420 of title
45 of the Code of Federal Regulations, that are applicable to
qualified health plans offered through an Exchange.
``(c) Premium.--
``(1) Amount of monthly premiums.--The Secretary shall
(beginning for the first year that begins more than 1 year
after the date of the enactment of this section), during
September of the preceding year, determine a monthly premium
for all individuals enrolled under this section. Such monthly
premium shall be equal to \1/12\ of the annual premium computed
under paragraph (2)(B), which shall apply with respect to
coverage provided under this section for any month in the
succeeding year.
``(2) Annual premium.--
``(A) Combined per capita average for all medicare
benefits.--The Secretary shall estimate the average,
annual per capita amount for benefits and
administrative expenses that will be payable under
parts A, B, and D (including, as applicable, under part
C) in the year for all individuals enrolled under this
section.
``(B) Annual premium.--The annual premium under
this subsection for months in a year is equal to the
average, annual per capita amount estimated under
subparagraph (A) for the year.
``(3) Increased premium for certain part c and d plans.--
Nothing in this section shall preclude an individual from
choosing a Medicare Advantage plan or a prescription drug plan
that requires the individual to pay an additional amount
(because of supplemental benefits or because it is a more
expensive plan). In such case the individual would be
responsible for the increased monthly premium.
``(d) Payment of Premiums.--
``(1) In general.--Premiums for enrollment under this
section shall be paid to the Secretary at such times, and in
such manner, as the Secretary determines appropriate.
``(2) Deposit into medicare buy-in trust fund.--Amounts
collected by the Secretary under this section shall be
deposited in the Medicare Buy-In Trust Fund established under
paragraph (3).
``(3) Medicare buy-in trust fund.--
``(A) In general.--There is hereby created on the
books of the Treasury of the United States a trust fund
to be known as the `Medicare Buy-In Trust Fund' (in
this paragraph referred to as the `Trust Fund'). The
Trust Fund shall consist of such gifts and bequests as
may be made as provided in section 201(i)(1) and such
amounts as may be deposited in, or appropriated to,
such fund as provided in this title.
``(B) Incorporation of provisions.--Subsections (b)
through (i) of section 1841 shall apply with respect to
the Trust Fund and this title in the same manner as
they apply with respect to the Federal Supplementary
Medical Insurance Trust Fund and part B, respectively,
except that in applying such section 1841, any
reference in such section to `this part' shall be
construed to be a reference to this section and any
reference in section 1841(h) to section 1840(d) and in
section 1841(i) to sections 1840(b)(1) and 1842(g) are
deemed to be references to comparable authority
exercised under this section.
``(e) Not Eligible for Medicare Cost-Sharing Assistance.--An
individual enrolled under this section shall not be treated as enrolled
under any part of this title for purposes of obtaining medical
assistance for Medicare cost-sharing or otherwise under title XIX.
``(f) Eligibility for Financial Assistance.--
``(1) In general.--Individuals enrolled in coverage under
this section shall, from amounts transferred under paragraph
(2), receive financial assistance for such coverage that is
substantially similar to the assistance the individual would
have received if the individual were enrolled in a qualified
health plan through an Exchange.
``(2) Transfer of funds to medicare buy-in trust fund.--
``(A) In general.--The Secretary shall transfer to
the Medicare Buy-In Trust Fund under subsection (d)(3)
for each plan year the amount determined under
paragraph (C) for such year.
``(B) Use of funds.--The amounts transferred to the
Medicare Buy-In Trust Fund under subparagraph (A) shall
only be used to reduce the premiums and cost-sharing
for coverage under this section of individuals enrolled
under such coverage who would be eligible for cost-
sharing reductions under section 1402 of the Patient
Protection and Affordable Care Act and premium
assistance under section 36B of the Internal Revenue
Code of 1986 if such individual were enrolled in a
qualified health plan.
``(C) Amount of transfer.--
``(i) In general.--The amount determined
under this subparagraph for any plan year is
the aggregate amount the Secretary determines
is equal to 100 percent of the premium tax
credits under section 36B of the Internal
Revenue Code of 1986, and 100 percent of the
cost-sharing reductions under section 1402 of
the Patient Protection and Affordable Care Act,
that would have been provided for the plan year
to eligible individuals who meet specified
income criteria and are enrolled for such plan
year in coverage provided through enrollment
under this section if such individuals were
enrolled for such year in a qualified health
plan through an Exchange.
``(ii) Specific requirements.--The
Secretary shall make the determination under
clause (i) on a per enrollee basis and shall
take into account all relevant factors
necessary to determine the value of the premium
tax credits and cost-sharing reductions that
would have been provided to eligible
individuals described in section 1331 of the
Patient Protection and Affordable Care Act,
including the age and income of the enrollee,
geographic differences in average spending for
health care across rating areas, the health
status of the enrollee for purposes of
determining risk adjustment payments and
reinsurance payments that would have been made
if the enrollee had enrolled in a qualified
health plan through an Exchange, and whether
any reconciliation of the credit or cost-
sharing reductions would have occurred if the
enrollee had been so enrolled. This
determination shall take into consideration the
experience of other States with respect to
participation in an Exchange and such credits
and reductions provided to residents of the
other States, with a special focus on enrollees
with income below 200 percent of poverty.
``(D) Certification.--
``(i) In general.--The Chief Actuary of the
Centers for Medicare & Medicaid Services, in
consultation with the Office of Tax Analysis of
the Department of the Treasury, shall certify
whether the methodology used to make
determinations under subparagraph (C), and such
determinations, meet the requirements of this
paragraph.
``(ii) Corrections.--The Secretary shall
adjust the payment to the Trust Fund for any
plan year to reflect any error in the
determinations under subparagraph (C) for any
preceding plan year.
``(iii) Application.--Coverage provided
through enrollment under this part and parts B
and D pursuant to this section shall be treated
as coverage under a qualified health plan in
the silver level of coverage in the individual
market offered through an Exchange and the
Secretary shall be treated as the issuer of
such plan.
``(g) Treatment in Relation to the Affordable Care Act.--
``(1) Satisfaction of individual mandate.--For purposes of
applying section 5000A of the Internal Revenue Code of 1986,
the coverage provided under this section constitutes minimum
essential coverage under subsection (f)(1)(A)(i) of such
section 5000A.
``(2) Eligibility for premium assistance.--Coverage
provided under this section--
``(A) shall be treated as coverage under a
qualified health plan in the individual market enrolled
in through the Exchange where the individual resides
for all purposes of section 36B of the Internal Revenue
Code of 1986 other than subsection (c)(2)(B) thereof;
and
``(B) shall not be treated as eligibility for other
minimum essential coverage for purposes of subsection
(c)(2)(B) of such section 36B.
The Secretary shall determine the applicable second lowest cost
silver plan which shall apply to coverage under this section
for purposes of determining the premium assistance amount under
section 36B(b)(2) of such Code. Notwithstanding the preceding
sentences, in determining the applicable second lowest cost
silver plan with respect to any taxpayer under section
36B(b)(3)(B) of such Code, coverage provided under this section
shall not be taken into account as a silver plan of the
individual market.
``(3) Eligibility for cost-sharing reductions.--For
purposes of applying section 1402 of the Patient Protection and
Affordable Care Act (42 U.S.C. 18071)--
``(A) coverage provided under this section shall be
treated as coverage under a qualified health plan in
the silver level of coverage in the individual market
offered through an Exchange; and
``(B) the Secretary shall be treated as the issuer
of such plan.
``(4) Medicaid managed care.--States are prohibited from
buying their Medicaid beneficiaries ages 50 to 64 into Medicare
under this section, and individuals otherwise eligible for
enrollment under a State plan under title XIX are prohibited
from coverage under this title pursuant to enrollment under
this section. The preceding sentence shall not apply to
Medicaid beneficiaries whose Medicaid coverage or eligibility
does not meet the definition of minimum essential coverage
under a government-sponsored program under section 1.5000A-2 of
title 26, Code of Federal Regulations (or any successor
regulation).
``(h) Guaranteed Issue of Medigap Policies Upon First Enrollment
and Each Subsequent Enrollment.--In the case of an individual who
enrolls under this section (including an individual who was previously
enrolled under this section), paragraphs (2)(A), (2)(D), (3)(B)(ii),
and (3)(B)(vi) of section 1882(s)--
``(1) shall be applied by substituting `50' for `65';
``(2) if the individual was enrolled under this section and
subsequently disenrolls, shall apply each time the individual
subsequently reenrolls under this section as if the individual
had attained 50 years of age on the date of such reenrollment
(and as if the individual had never previously enrolled in a
Medicare supplemental policy); and
``(3) shall be applied as if this section had not been
enacted (and as if the individual had never previously enrolled
in a Medicare supplemental policy) when the individual attains
65 years of age.
``(i) Oversight.--There is established an advisory committee to be
known as the `Medicare Buy In Oversight Board' to monitor and oversee
the implementation of this section, including the experience of the
individuals enrolling under this section. The Medicare Buy In Oversight
Board shall make periodic recommendations for the continual improvement
of the implementation of this section as well as the relationship of
enrollment under this section to other health care programs.
``(j) Outreach and Enrollment.--
``(1) In general.--During the period that begins on January
1, 2019, and ends on December 31, 2021, the Secretary shall
award grants to eligible entities for the following purposes:
``(A) Outreach and enrollment.--To carry out
outreach, public education activities, and enrollment
activities to raise awareness of the availability of,
and encourage, enrollment under this section.
``(B) Assisting individuals' transition under this
section.--To provide assistance to individuals to
enroll under this section.
``(C) Raising awareness of premium assistance and
cost-sharing reductions.--To distribute fair and
impartial information concerning enrollment under this
section and the availability of premium assistance tax
credits under section 36B of the Internal Revenue Code
of 1986 and cost-sharing reductions under section 1402
of the Patient Protection and Affordable Care Act, and
to assist eligible individuals in applying for such tax
credits and cost-sharing reductions.
``(2) Eligible entities.--
``(A) In general.--In this subsection, the term
`eligible entity' means--
``(i) a State; or
``(ii) a nonprofit community-based
organization.
``(B) Enrollment agents.--Such term includes a
licensed independent insurance agent or broker that has
an arrangement with a State or nonprofit community-
based organization to enroll eligible individuals under
this section.
``(C) Exclusions.--Such term does not include an
entity that--
``(i) is a health insurance issuer; or
``(ii) receives any consideration, either
directly or indirectly, from any health
insurance issuer in connection with the
enrollment of any individuals under this
section.
``(3) Priority.--In awarding grants under this subsection,
the Secretary shall give priority to awarding grants to States
or eligible entities in States that have geographic rating
areas at risk of having no qualified health plans in the
individual market.
``(4) Funding.--For purposes of carrying out this
subsection, there is appropriated to the Secretary, out of any
moneys in the Treasury not otherwise appropriated, $500,000,000
for calendar year 2019 and for each subsequent calendar year.
``(k) No Effect on Benefits for Individuals Otherwise Eligible or
on Trust Funds.--The Secretary shall implement the provisions of this
section in such a manner to ensure that such provisions--
``(1) have no effect on the benefits under this title for
individuals who are entitled to, or enrolled for, such benefits
other than through this section; and
``(2) have no negative impact on the Federal Hospital
Insurance Trust Fund or the Federal Supplementary Medical
Insurance Trust Fund (including the Medicare Prescription Drug
Account within such Trust Fund).
``(l) Consultation.--In promulgating regulations to implement this
section, the Secretary shall consult with interested parties, including
groups representing beneficiaries, health care providers, employers,
and insurance companies.''.
SEC. 3. AUTHORITY TO NEGOTIATE FAIR PRICES FOR MEDICARE PRESCRIPTION
DRUGS.
(a) In General.--Section 1860D-11 of the Social Security Act (42
U.S.C. 1395w-111) is amended by striking subsection (i).
(b) Effective Date.--The amendment made by this section shall take
effect on the date of the enactment of this Act.
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