I 

114TH CONGRESS 

1ST SESSION H. R. 4090 

To amend the Social Security Act to improve choices available to Medicare 

eligible seniors by permitting them to elect (instead of regular Medicare 

benefits) to receive a voucher for a health savings account, for premiums 

for a high deductible health insurance plan, or both and by suspending 

Medicare late enrollment penalties between ages 65 and 70. 

IN THE HOUSE OF REPRESENTATIVES 

NOVEMBER 19, 2015 

Mrs. BLACKBURN introduced the following bill; which was referred to the 

Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the 

Speaker, in each case for consideration of such provisions as fall within 

the jurisdiction of the committee concerned 

A BILL 

To amend the Social Security Act to improve choices available to Medicare eligible seniors by permitting them to 

elect (instead of regular Medicare benefits) to receive 

a voucher for a health savings account, for premiums 

for a high deductible health insurance plan, or both 

and by suspending Medicare late enrollment penalties 

between ages 65 and 70. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Health Care Choices 

3 for Seniors Act’’. 

4 SEC. 2. FINDINGS. 

5 Congress finds the following: 

6 (1) The Social Security Administration’s Pro7 gram Operations Manual System section HI 

8 00801.002, titled ‘‘Waiver of Hospital Insurance 

9 Entitlement by Monthly Beneficiary’’, provides that 

10 an individual who does not sign up for part A of the 

11 Medicare program when the individual signs up for 

12 social security benefits will lose such benefits, re13 gardless of the desire of the individual to not partici14 pate in the Medicare program because of religious or 

15 philosophical reasons or a preference to have private 

16 health insurance. 

17 (2) As part of the Medicare Prescription Drug, 

18 Improvement, and Modernization Act of 2003 (Pub19 lic Law 108–173), Congress increased health insur20 ance options by authorizing health savings accounts 

21 into which individuals may make annual contribu22 tions of not more than $2,650 and families may 

23 make such contributions of not more than $5,250 

24 that are allowable as deductions for income tax pur25 poses. Seniors are not allowed to deduct contribu26 tions to their health savings account after the date 


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1 of the entitlement of such seniors to Medicare bene2 fits. 

3 (3) Section 1802(b) of the Social Security Act 

4 (42 U.S.C. 1395a(b)), added by section 4507 of the 

5 Balanced Budget Act of 1997, states that a Medi6 care beneficiary may only enter into a private con7 tract with a physician for an item or service if no 

8 claim for payment under title XVIII of such Act will 

9 be submitted. In the case of such contract, the phy10 sician must sign an affidavit that acknowledges such 

11 contract and that provides that the physician will 

12 not submit a claim, and will forgo reimbursement, 

13 under such title for an item or service provided to 

14 any Medicare beneficiary for a period of two years. 

15 SEC. 3. AUTHORITY TO ELECT VOUCHER PROGRAM IN16 STEAD OF MEDICARE PART A ENTITLEMENT. 

17 (a) IN GENERAL.—Section 226 of the Social Security 

18 Act (42 U.S.C. 426) is amended by adding at the end the 

19 following new subsections: 

20 ‘‘(k) WAIVER OF ENTITLEMENT AND ELECTION OF

21 VOUCHER PROGRAM.— 

22 ‘‘(1) IN GENERAL.—Notwithstanding the pre23 vious provisions of this section, the Secretary shall 

24 establish a procedure under which an individual oth25 erwise entitled under subsection (a) to benefits 


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1 under part A of title XVIII may waive such entitle2 ment and be automatically enrolled in the Medicare 

3 Alternative Voucher Program established under sub4 section (l) if— 

5 ‘‘(A) at the time such waiver is made the 

6 individual— 

7 ‘‘(i) has a health savings account de8 scribed in subsection (d) of section 223 of 

9 the Internal Revenue Code of 1986 (26 

10 U.S.C. 223); and 

11 ‘‘(ii) is enrolled under a high deduct12 ible health plan, as defined in subsection 

13 (c)(1) of such section; and 

14 ‘‘(B) the individual makes such waiver dur15 ing the initial enrollment period described in 

16 section 1837(d). 

17 ‘‘(2) TREATMENT UNDER THE INTERNAL REV18 ENUE CODE OF 1986.—An individual who waives en19 titlement under paragraph (1) shall not be treated 

20 as entitled to benefits under title XVIII for purposes 

21 of section 223(b)(7) of the Internal Revenue Code of 

22 1986. 

23 ‘‘(3) INELIGIBILITY FOR PART B OR D BENE24 FITS.—An individual shall not be eligible for benefits 

25 under part B or D of title XVIII during the period 


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1 for which the individual waives entitlement under 

2 part A of such title under paragraph (1). 

3 ‘‘(4) TERMINATION OF WAIVER AND REENROLL4 MENT UNDER MEDICARE PROGRAM.—The Secretary 

5 shall establish a procedure under which an individual 

6 who waives entitlement under paragraph (1) may 

7 terminate such waiver during an annual period that 

8 shall be the same as the annual general enrollment 

9 period described in section 1837(e). For purposes of 

10 applying parts B and D of title XVIII, such indi11 vidual shall be treated as if the individual were enti12 tled to benefits under part A of such title as of the 

13 date such individual terminates the waiver under 

14 this paragraph. An individual who has terminated 

15 such a waiver may not subsequently make such a 

16 waiver. 

17 ‘‘(l) MEDICARE ALTERNATIVE VOUCHER PRO18 GRAM.— 

19 ‘‘(1) ESTABLISHMENT OF PROGRAM.—The Sec20 retary shall establish a program to be known as the 

21 Medicare Alternative Voucher Program (in this sub22 section referred to as the ‘voucher program’) con23 sistent with this subsection. 

24 ‘‘(2) AUTOMATIC ENROLLMENT.—An individual 

25 who waives entitlement under subsection (k)(1) shall 


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1 be enrolled in the voucher program for the period 

2 during which such waiver is in effect. 

3 ‘‘(3) AMOUNT OF VOUCHER.— 

4 ‘‘(A) AMOUNT BASED ON AGE COHORT.— 

5 ‘‘(i) IN GENERAL.—Subject to clause 

6 (ii), for each month that an individual 

7 within an age cohort is enrolled in the 

8 voucher program, the Secretary shall pro9 vide a voucher to such individual in an 

10 amount that is equal to the monthly actu11 arial rate for that month computed under 

12 section 1818(d)(1) multiplied by the age 

13 cohort adjustment factor for such age co14 hort under subparagraph (B). 

15 ‘‘(ii) MONTHLY LIMIT.—The amount 

16 of a voucher provided to an individual for 

17 a month may not exceed $200. 

18 ‘‘(B) AGE COHORT ADJUSTMENT FAC19 TOR.—For each age cohort the Secretary shall 

20 determine an age cohort adjustment factor 

21 equal to the ratio of— 

22 ‘‘(i) the monthly actuarial rate de23 scribed in section 1818(d)(1) as deter24 mined by the Secretary for individuals in 

25 such age cohort, to 


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1 ‘‘(ii) the monthly actuarial rate de2 scribed in such section. 

3 ‘‘(C) AGE COHORT DEFINED.—For pur4 poses of this paragraph, an ‘age cohort’ means 

5 a group of individuals whose age falls within a 

6 span of five consecutive years, consistent with 

7 the following: 

8 ‘‘(i) The first such span begins at age 

9 65. 

10 ‘‘(ii) Other spans follow consecutively. 

11 ‘‘(4) PERMISSIBLE USE OF VOUCHER.—A 

12 voucher under paragraph (3) may be used only for 

13 the following purposes: 

14 ‘‘(A) As a contribution into a health sav15 ings account established by such individual, as 

16 described in subsection (k)(1)(A). 

17 ‘‘(B) For payment of premiums for enroll18 ment of such individual under a high deductible 

19 health plan described in such subsection. 

20 ‘‘(5) EFFECT OF SUBSEQUENT TERMINATION

21 OF WAIVER.—If an individual terminates a waiver 

22 under subsection (k)(3), the enrollment of such indi23 vidual in the voucher program shall be terminated 

24 on the date on which the termination becomes effec25 tive.’’. 


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1 (b) AMENDMENT OF INTERNAL REVENUE CODE OF

2 1986.—Paragraph (7) of section 223(b) of the Internal 

3 Revenue Code of 1986 (relating to Medicare eligible indi4 viduals) is amended to read as follows: 

5 ‘‘(7) MEDICARE ELIGIBLE INDIVIDUALS.— 

6 ‘‘(A) IN GENERAL.—The limitation under 

7 this subsection for any month with respect to 

8 an individual shall be zero for any month such 

9 individual is entitled to benefits under title 

10 XVIII of the Social Security Act. 

11 ‘‘(B) MEDICARE ALTERNATIVE VOUCHER

12 PROGRAM.—In the case of an individual who is 

13 enrolled in the Medicare Alternative Voucher 

14 Program under section 226(l) of the Social Se15 curity Act, the applicable limitation under sub16 paragraphs (A) and (B) of paragraph (2) shall 

17 be increased by the amount of the voucher de18 scribed in paragraph (3) of such section which 

19 is contributed to a health savings account of 

20 such individual.’’. 

21 (c) EFFECTIVE DATE.— 

22 (1) IN GENERAL.—The amendment made by 

23 subsection (a) shall take effect on the date that is 

24 six months after the date of the enactment of this 

25 Act and shall apply to an individual who becomes 


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1 entitled to benefits under part A of title XVIII of 

2 the Social Security Act on or after such date of the 

3 enactment. 

4 (2) AMENDMENT OF INTERNAL REVENUE CODE

5 OF 1986.—The amendment made by subsection (b) 

6 shall apply to months ending after the date referred 

7 to in paragraph (1), in taxable years ending after 

8 such date. 

9 SEC. 4. SUSPENSION OF MEDICARE LATE ENROLLMENT 

10 PENALTIES BETWEEN AGES 65 AND 70. 

11 (a) PART B.—The second sentence of section 1839(b) 

12 of the Social Security Act (42 U.S.C. 1395r(b)) is amend13 ed by inserting before the period the following: ‘‘and there 

14 shall not be taken into account (for individuals not entitled 

15 to benefits under section 226A) any month during any 

16 part of which the individual attained age 65 and has not 

17 attained age 70’’. 

18 (b) PART D.— 

19 (1) IN GENERAL.—Section 1860D–13(b)(7)(A) 

20 of such Act (42 U.S.C. 1395w–113(b)(7)(A)) is 

21 amended by adding at the end the following sen22 tence: ‘‘For purposes of the preceding sentence, in 

23 the case of an individual not entitled to benefits 

24 under part A under section 226A, a continuous pe25 riod of eligibility shall not include any month during 


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1 any part of which the individual attained age 65 and 

2 has not attained age 70.’’. 

3 (2) CONFORMING AMENDMENT.—Section 

4 1860D–1(b)(6)(A) of such Act (42 U.S.C. 1395w– 

5 101(b)(6)(A)) is amended by inserting after ‘‘para6 graph (2)’’ the following: ‘‘, but excluding the period 

7 between 65 and 70 years of age’’. 

8 (c) EFFECTIVE DATE.—The amendments made by 

9 this section shall apply to individuals who attain 65 years 

10 of age in a month after the month in which this Act is 

11 enacted. 

Æ 


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