[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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