[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 3747 Introduced in Senate (IS)]








109th CONGRESS
  2d Session
                                S. 3747

   To amend title XVIII of the Social Security Act and the Employee 
 Retirement Income Security Act of 1974 to provide access to Medicare 
 benefits for individuals ages 55 to 65, to amend the Internal Revenue 
   Code of 1986 to allow a refundable and advanceable credit against 
    income tax for payment of such premiums, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                July 27 (legislative day, July 26), 2006

Mr. Rockefeller (for himself, Mr. Kerry, Mr. Kennedy, and Mr. Sarbanes) 
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 and the Employee 
 Retirement Income Security Act of 1974 to provide access to Medicare 
 benefits for individuals ages 55 to 65, to amend the Internal Revenue 
   Code of 1986 to allow a refundable and advanceable credit against 
    income tax for payment of such premiums, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Medicare Early 
Access Act of 2006''.
    (b) Table of Contents.--

Sec. 1. Short title; table of contents.
TITLE I--ACCESS TO MEDICARE BENEFITS FOR INDIVIDUALS 55 TO 65 YEARS OF 
                                  AGE

Sec. 101. Access to Medicare benefits for individuals 55 to 65 years of 
                            age.
``PART E--Purchase of Medicare Benefits by Certain Individuals 55 to 65 
                              Years of Age

        ``Sec. 1860E-1. Program benefits; eligibility.
        ``Sec. 1860E-2. Enrollment process; coverage.
        ``Sec. 1860E-3. Premiums.
        ``Sec. 1860E-4. Payment of premiums.
        ``Sec. 1860E-5. Provisions relating to Employment-Based retiree 
                            health coverage.
        ``Sec. 1860E-6. Medicare Early Access Trust Fund.
        ``Sec. 1860E-7. Oversight and accountability.
        ``Sec. 1860E-8. Administration and miscellaneous.
  TITLE II--REFUNDABLE AND ADVANCEABLE CREDIT AGAINST INCOME TAX FOR 
                     MEDICARE EARLY ACCESS PREMIUMS

Sec. 201. Refundable and advanceable income tax credit for Medicare 
                            early access premiums.

TITLE I--ACCESS TO MEDICARE BENEFITS FOR INDIVIDUALS 55 TO 65 YEARS OF 
                                  AGE

SEC. 101. ACCESS TO MEDICARE BENEFITS FOR INDIVIDUALS 55 TO 65 YEARS OF 
              AGE.

    (a) In General.--Title XVIII of the Social Security Act is 
amended--
            (1) by redesignating part E as part F; and
            (2) by inserting after part D the following new part:

``PART E--PURCHASE OF MEDICARE BENEFITS BY CERTAIN INDIVIDUALS 55 TO 65 
                              YEARS OF AGE

``SEC. 1860E-1. PROGRAM BENEFITS; ELIGIBILITY.

    ``(a) Entitlement to Medicare Benefits for Enrolled Individuals.--
            ``(1) In general.--An individual enrolled under this part 
        is entitled to the same benefits under this title as an 
        individual entitled to benefits or enrolled under any part of 
        this title.
            ``(2) Definitions.--For purposes of this part:
                    ``(A) Federal or state cobra continuation 
                provision.--The term `Federal or State COBRA 
                continuation provision' has the meaning given the term 
                `COBRA continuation provision' in section 2791(d)(4) of 
                the Public Health Service Act and includes a comparable 
                State program, as determined by the Secretary.
                    ``(B) Federal health insurance program defined.--
                The term `Federal health insurance program' means any 
                of the following:
                            ``(i) Medicare.--Any part of this title 
                        (other than by reason of this part).
                            ``(ii) Medicaid.--A State plan under title 
                        XIX.
                            ``(iii) FEHBP.--The Federal employees 
                        health benefit program under chapter 89 of 
                        title 5, United States Code.
                            ``(iv) TRICARE.--The TRICARE program (as 
                        defined in section 1072(7) of title 10, United 
                        States Code).
                            ``(v) Active duty military.--Health 
                        benefits under title 10, United States Code, to 
                        an individual as a member of the uniformed 
                        services of the United States.
                    ``(C) Group health plan.--The term `group health 
                plan' has the meaning given such term in section 
                2791(a)(1) of the Public Health Service Act.
    ``(b) Eligibility of Individuals Age 55 to 65 Years of Age.--
            ``(1) In general.--Subject to paragraph (2), an individual 
        who meets the following requirements with respect to a month is 
        eligible to enroll under this part with respect to such month:
                    ``(A) Age.--As of the last day of the month, the 
                individual has attained 55 years of age, but has not 
                attained 65 years of age.
                    ``(B) Medicare eligibility (but for age).--The 
                individual would be eligible for benefits under part A 
                or part B for the month if the individual were 65 years 
                of age.
                    ``(C) Not eligible for coverage under group health 
                plans or federal health insurance programs.--The 
                individual is not eligible for benefits or coverage 
                under a Federal health insurance program (as defined in 
                subsection (a)(2)(B)) or under a group health plan 
                (other than such eligibility merely through a Federal 
                or State COBRA continuation provision) as of the last 
                day of the month involved.
            ``(2) Limitation on eligibility if terminated enrollment.--
        If an individual described in paragraph (1) enrolls under this 
        part and coverage of the individual is terminated under section 
        1860E-2(d) (other than because of age), the individual is not 
        again eligible to enroll under this subsection unless the 
        following requirements are met:
                    ``(A) New coverage under group health plan or 
                federal health insurance program.--After the date of 
                termination of coverage under such section, the 
                individual obtains coverage under a group health plan 
                or under a Federal health insurance program.
                    ``(B) Subsequent loss of new coverage.--The 
                individual subsequently loses eligibility for the 
                coverage described in subparagraph (A) without regard 
                to whether the individual has exhausted any eligibility 
                the individual may subsequently have for coverage under 
                a Federal or State COBRA continuation provision.
            ``(3) Change in health plan eligibility does not affect 
        coverage.--In the case of an individual who is eligible for and 
        enrolls under this part under this subsection, the individual's 
        continued entitlement to benefits under this part shall not be 
        affected by the individual's subsequent eligibility for 
        benefits or coverage described in paragraph (1)(C), or 
        entitlement to such benefits or coverage.

``SEC. 1860E-2. ENROLLMENT PROCESS; COVERAGE.

    ``(a) In General.--An individual may enroll in the program 
established under this part only in such manner and form as may be 
prescribed by regulations, and only during an enrollment period 
prescribed by the Secretary consistent with the provisions of this 
section. Such regulations shall provide a process under which 
individuals eligible to enroll as of a month are permitted to pre-
enroll during a prior month within an enrollment period described in 
subsection (b).
    ``(b) Enrollment Periods.--
            ``(1) Individuals 55 to 65 years of age.--In the case of 
        individuals eligible to enroll under this part under section 
        1860E-1(b)--
                    ``(A) Initial enrollment period.--If the individual 
                is eligible to enroll under such section for January 
                2007, the enrollment period shall begin on November 1, 
                2006, and shall end on February 28, 2007. Any such 
                enrollment before January 1, 2007, is conditioned upon 
                compliance with the conditions of eligibility for 
                January 2007.
                    ``(B) Subsequent periods.--If the individual is 
                eligible to enroll under such section for a month after 
                January 2007, the enrollment period shall begin on the 
                first day of the second month before the month in which 
                the individual first is eligible to so enroll and shall 
                end four months later. Any such enrollment before the 
                first day of the third month of such enrollment period 
                is conditioned upon compliance with the conditions of 
                eligibility for such third month.
            ``(2) Authority to correct for government errors.--The 
        provisions of section 1837(h) apply with respect to enrollment 
        under this part in the same manner as they apply to enrollment 
        under part B.
    ``(c) Date Coverage Begins.--
            ``(1) In general.--The period during which an individual is 
        entitled to benefits under this part shall begin as follows, 
        but in no case earlier than January 1, 2007:
                    ``(A) In the case of an individual who enrolls 
                (including pre-enrolls) before the month in which the 
                individual satisfies eligibility for enrollment under 
                section 1860E-1, the first day of such month of 
                eligibility.
                    ``(B) In the case of an individual who enrolls 
                during or after the month in which the individual first 
                satisfies eligibility for enrollment under such 
                section, the first day of the following month.
            ``(2) Authority to provide for partial months of 
        coverage.--Under regulations, the Secretary may, in the 
        Secretary's discretion, provide for coverage periods that 
        include portions of a month in order to avoid lapses of 
        coverage.
            ``(3) Limitation on payments.--No payments may be made 
        under this title with respect to the expenses of an individual 
        enrolled under this part unless such expenses were incurred by 
        such individual during a period which, with respect to the 
        individual, is a coverage period under this section.
    ``(d) Termination of Coverage.--
            ``(1) In general.--An individual's coverage period under 
        this part shall continue until the individual's enrollment has 
        been terminated at the earliest of the following:
                    ``(A) General provisions.--
                            ``(i) Notice.--The individual files notice 
                        (in a form and manner prescribed by the 
                        Secretary) that the individual no longer wishes 
                        to participate in the insurance program under 
                        this part.
                            ``(ii) Nonpayment of premiums.--The 
                        individual fails to make payment of premiums 
                        required for enrollment under this part.
                            ``(iii) Medicare eligibility.--The 
                        individual becomes entitled to benefits or 
                        enrolled under any other part of this title 
                        (other than by reason of this part).
                    ``(B) Termination based on age.--The individual 
                attains 65 years of age.
            ``(2) Effective date of termination.--
                    ``(A) Notice.--The termination of a coverage period 
                under paragraph (1)(A)(i) shall take effect at the 
                close of the month following for which the notice is 
                filed.
                    ``(B) Nonpayment of premium.--The termination of a 
                coverage period under paragraph (1)(A)(ii) shall take 
                effect on a date determined under regulations, which 
                may be determined so as to provide a grace period in 
                which overdue premiums may be paid and coverage 
                continued. The grace period determined under the 
                preceding sentence shall not exceed 60 days; except 
                that it may be extended for an additional 30 days in 
                any case where the Secretary determines that there was 
                good cause for failure to pay the overdue premiums 
                within such 60-day period.
                    ``(C) Age or medicare eligibility.--The termination 
                of a coverage period under paragraph (1)(A)(iii) or 
                (1)(B) shall take effect as of the first day of the 
                month in which the individual attains 65 years of age 
                or becomes entitled to benefits or enrolled in any 
                other part of this title (other than by reason of this 
                part).

``SEC. 1860E-3. PREMIUMS.

    ``(a) Amount of Monthly Premiums.--The Secretary shall, during 
September of each year (beginning with 2006), determine a monthly 
premium for individuals 55 years of age or older, equal to \1/12\ of 
the annual premium computed under subsection (b)(2), which shall apply 
with respect to coverage provided under this title for any month in the 
succeeding year.
    ``(b) Annual Premium.--
            ``(1) National, per capita average.--The Secretary shall 
        estimate the average, annual per capita amount that would be 
        payable under this title with respect to individuals residing 
        in the United States who meet the requirement of section 1860E-
        1(b)(1)(A) as if all such individuals were eligible for (and 
        enrolled) under this title during the entire year (and assuming 
        that section 1862(b)(2)(A)(i) did not apply).
            ``(2) Annual premium.--The annual premium under this 
        subsection for months in a year is equal to the average, annual 
        per capita amount estimated under paragraph (1) for the year.

``SEC. 1860E-4. PAYMENT OF PREMIUMS.

    ``(a) Payment of Monthly Premium.--
            ``(1) In general.--The Secretary shall provide for payment 
        and collection of the monthly premium, determined under section 
        1860E-3(a) for the age of the individual involved, in the same 
        manner as for payment of monthly premiums under section 1840, 
        except that, for purposes of applying this section, any 
        reference in such section to the Federal Supplementary Medical 
        Insurance Trust Fund is deemed a reference to the Trust Fund 
        established under section 1860E-6.
            ``(2) Period of payment.--In the case of an individual who 
        participates in the program established by this title, the 
        monthly premium shall be payable for the period commencing with 
        the first month of the individual's coverage period and ending 
        with the month in which the individual's coverage under this 
        title terminates.
    ``(b) Application of Certain Provisions.--The provisions of section 
1840 (other than subsection (h)) shall apply to premiums collected 
under this section in the same manner as they apply to premiums 
collected under part B, except that any reference in such section to 
the Federal Supplementary Medical Insurance Trust Fund is deemed a 
reference to the Trust Fund established under section 1860E-6.

``SEC. 1860E-5. PROVISIONS RELATING TO EMPLOYMENT-BASED RETIREE HEALTH 
              COVERAGE.

    ``(a) In General.--In the case of an individual who would be 
eligible to enroll under this part but for the provision of employment-
based retiree health coverage by an employer to the individual, 
notwithstanding the limitation under section 1860E-1(b)(1)(C), the 
individual is eligible to enroll under this part.
    ``(b) Maintenance of Effort.--In the case of an employer that 
offers employment-based retiree health coverage to an individual who 
enrolls under this part, upon enrollment of the individual under this 
part, the employer may modify such coverage to provide for the 
following benefits:
            ``(1) Payment is made by the employer under such coverage 
        for items and services for which payment may not be made under 
        this title.
            ``(2) Payment is made by the employer sponsoring such 
        coverage of 25 percent of the monthly premium under section 
        1860E-3 applicable to the individual after enrollment under 
        this part.
    ``(c) Employment-Based Retiree Health Coverage.--The term 
`employment-based retiree health coverage' has the meaning given that 
term in section 1860D-22(c)(1), except that, for purposes of this part, 
any reference in such section to `part D' is deemed to be a reference 
to `part E'.

``SEC. 1860E-6. MEDICARE EARLY ACCESS TRUST FUND.

    ``(a) Establishment of Trust Fund.--
            ``(1) 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 Early Access Trust Fund' (in this section 
        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.
            ``(2) Premiums.--Premiums collected under section 1860E-3 
        and payable under section 1860E-5(a)(2) shall be transferred to 
        the Trust Fund.
    ``(b) Incorporation of Provisions.--
            ``(1) In general.--Subject to paragraph (2), 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.
            ``(2) Miscellaneous references.--In applying provisions of 
        section 1841 under paragraph (1)--
                    ``(A) any reference in such section to `this part' 
                is construed to refer to this part E;
                    ``(B) 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 references to comparable 
                authority exercised under this part; and
                    ``(C) payments may be made under section 1841(g) to 
                the Trust Funds under sections 1817 and 1841 as 
                reimbursement to such funds for payments they made for 
                benefits provided under this part.

``SEC. 1860E-7. OVERSIGHT AND ACCOUNTABILITY.

    ``(a) Through Annual Reports of Trustees.--The Board of Trustees of 
the Medicare Early Access Trust Fund under section 1860E-6(b)(1) shall 
report on an annual basis to Congress concerning the status of the 
Trust Fund and the need for adjustments in the program under this part 
to maintain financial solvency of the program under this part.
    ``(b) Periodic GAO Reports.--The Comptroller General of the United 
States shall periodically submit to Congress reports on the adequacy of 
the financing of coverage provided under this part. The Comptroller 
General shall include in such report such recommendations for 
adjustments in such financing and coverage as the Comptroller General 
deems appropriate in order to maintain financial solvency of the 
program under this part.

``SEC. 1860E-8. ADMINISTRATION AND MISCELLANEOUS.

    ``(a) Treatment for Purposes of Title.--Except as otherwise 
provided in this part--
            ``(1) individuals enrolled under this part shall be treated 
        for purposes of this title as though the individual were 
        entitled to benefits and enrolled under any part of this title; 
        and
            ``(2) benefits described in section 1860E-1 shall be 
        payable under this title to such individuals in the same manner 
        as if such individuals were so entitled and enrolled.
    ``(b) Not Treated as Medicare Program for Purposes of Medicaid 
Program.--For purposes of applying title XIX (including the provision 
of medicare cost-sharing assistance under such title), an individual 
who is enrolled under this part shall not be treated as being entitled 
to benefits under this title.
    ``(c) Not Treated as Medicare Program for Purposes of COBRA 
Continuation Provisions.--In applying a COBRA continuation provision 
(as defined in section 2791(d)(4) of the Public Health Service Act), 
any reference to an entitlement to benefits under this title shall not 
be construed to include entitlement to benefits under this title 
pursuant to the operation of this part.''.
    (b) Conforming Amendments to Social Security Act Provisions.--(1) 
Section 201(i)(1) of the Social Security Act (42 U.S.C. 401(i)(1)) is 
amended by striking ``or the Federal Supplementary Medical Insurance 
Trust Fund'' and inserting ``the Federal Supplementary Medical 
Insurance Trust Fund, and the Medicare Early Access Trust Fund''.
    (2) Section 201(g)(1)(A) of such Act (42 U.S.C. 401(g)(1)(A)) is 
amended by striking ``and the Federal Supplementary Medical Insurance 
Trust Fund established by title XVIII'' and inserting ``, the Federal 
Supplementary Medical Insurance Trust Fund, and the Medicare Early 
Access Trust Fund established by title XVIII''.
    (3) Section 1820(i) of such Act (42 U.S.C. 1395i-4(i)) is amended 
by striking ``part D'' and inserting ``part F''.
    (4) Section 1853 of such Act (42 U.S.C. 1395w-23) is amended by 
adding at the end the following new subsection:
    ``(k) Adjustment for Early Access.--In applying this section with 
respect to individuals entitled to benefits under part E, the Secretary 
shall provide for an appropriate adjustment in, for 2007, the annual MA 
capitation rate, and for years beginning with 2008, the payment amount 
determined under this section or section 1858, as may be appropriate to 
reflect differences between the population served under such part and 
the population under parts A and B.''.
    (5) Section 1860D-15(c)(1) of such Act (42 U.S.C. 1395w-115(c)(1)) 
is amended by adding at the end the following new subparagraph:
                    ``(E) Adjustment for early access.--In applying 
                this section with respect to individuals entitled to 
                benefits under part E, the Secretary shall provide for 
                an appropriate adjustment in the payment amount 
                determined under this section as may be appropriate to 
                reflect differences between the population served under 
                such part and the population under parts A and B.''.
    (c) Other Conforming Amendments.--(1) Section 602(2)(D)(ii) of the 
Employee Retirement Income Security Act of 1974 (29 U.S.C. 1162(2)) is 
amended by inserting ``(not including an individual who is so entitled 
pursuant to enrollment under section 1860E-1)'' after ``Social Security 
Act''.
    (2) Section 2202(2)(D)(ii) of the Public Health Service Act (42 
U.S.C. 300bb-2(2)(D)(ii)) is amended by inserting ``(not including an 
individual who is so entitled pursuant to enrollment under section 
1860E-1)'' after ``Social Security Act''.
    (3) Section 4980B(f)(2)(B)(i)(V) of the Internal Revenue Code of 
1986 is amended by inserting ``(not including an individual who is so 
entitled pursuant to enrollment under section 1860E-1)'' after ``Social 
Security Act''.

  TITLE II--REFUNDABLE AND ADVANCEABLE CREDIT AGAINST INCOME TAX FOR 
                     MEDICARE EARLY ACCESS PREMIUMS

SEC. 201. REFUNDABLE AND ADVANCEABLE INCOME TAX CREDIT FOR MEDICARE 
              EARLY ACCESS PREMIUMS.

    (a) In General.--Subpart C of part IV of subchapter A of chapter 1 
of the Internal Revenue Code of 1986 (relating to refundable personal 
credits) is amended by redesignating section 36 as section 37 and by 
inserting after section 35 the following new section:

``SEC. 36. MEDICARE EARLY ACCESS PREMIUMS.

    ``(a) In General.--In the case of an individual, there shall be 
allowed as a credit against the tax imposed by this chapter for the 
taxable year an amount equal to 75 percent of the amount paid during 
such year as medicare early access coverage premiums.
    ``(b) Definitions.--For purposes of this section the term `medicare 
early access coverage premiums' means premiums paid under part E of 
title XVIII of the Social Security Act.
    ``(c) Coordination With Advance Payment.--With respect to any 
taxable year, the amount which would (but for this subsection) be 
allowed as a credit under subsection (a) shall be reduced (but not 
below zero) by the aggregate amount paid on behalf of such taxpayer 
under section 7529 for such taxable year.''.
    (b) Advance Payment of Credit.--Chapter 77 of such Code (relating 
to miscellaneous provisions) is amended by adding at the end the 
following new section:

``SEC. 7529. ADVANCE PAYMENT OF CREDIT FOR MEDICARE EARLY ACCESS 
              PREMIUMS.

    ``(a) General Rule.--The Secretary shall establish a program for 
making payments on behalf of individuals enrolled under part E of title 
XVIII of the Social Security Act to the Secretary of Health and Human 
Services for premiums payable by such individuals under such part.
    ``(b) Limitation on Advance Payments During Any Taxable Year.--The 
Secretary may make payments under subsection (a) only to the extent 
that the total amount of such payments made on behalf of any individual 
during the taxable year does not exceed the amount allowable as a 
credit to such individual for such year under section 36 (determined 
without regard to subsection (c) thereof).''.
    (c) Conforming Amendments.--
            (1) Paragraph (2) of section 1324(b) of title 31, United 
        States Code, is amended by inserting ``or 36'' after ``section 
        35''.
            (2) The table of sections for subpart C of part IV of 
        subchapter A of chapter 1 of the Internal Revenue Code of 1986 
        is amended by striking the item relating to section 36 and 
        inserting the following new items:

``36. Medicare early access premiums.
``37. Overpayments of tax.''.
            (3) The table of sections for chapter 77 of such Code is 
        amended by adding at the end the following new item:

``7529. Advance payment of credit for medicare early access premiums''.
    (d) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 2006.
                                 <all>