II 

118TH CONGRESS 

1ST SESSION S. 3113 

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 

OCTOBER 24, 2023 

Mr. BROWN (for himself, Mr. BLUMENTHAL, and Mr. FETTERMAN) 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. 

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

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Expanding Health 

5 Care Options for First Responders Act’’. 


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1 SEC. 2. MEDICARE BUY-IN OPTION FOR FIRST RESPOND2 ERS 50 TO 64 YEARS OF AGE WHO ARE SEPA3 RATED FROM SERVICE DUE TO RETIREMENT 

4 OR DISABILITY. 

5 (a) IN GENERAL.—Title XVIII of the Social Security 

6 Act (42 U.S.C. 1395c et seq.) is amended by adding at 

7 the end the following new section: 

8 ‘‘SEC. 1899C. MEDICARE BUY-IN OPTION FOR FIRST RE9 SPONDERS 50 TO 64 YEARS OF AGE WHO ARE 

10 SEPARATED FROM SERVICE DUE TO RETIRE11 MENT OR DISABILITY. 

12 ‘‘(a) IN GENERAL.—Every individual who meets the 

13 requirements described in subsection (c) shall be eligible 

14 to enroll under this section. 

15 ‘‘(b) PART A, B, AND D BENEFITS.—An individual 

16 enrolled under this section is entitled to the same benefits 

17 (and shall receive the same protections) under this title 

18 as an individual who is entitled to benefits under part A 

19 and enrolled under parts B and D, including the ability 

20 to enroll in a Medicare Advantage plan that provides 

21 qualified prescription drug coverage (an MA–PD plan). 

22 ‘‘(c) REQUIREMENTS FOR ELIGIBILITY.—The re23 quirements described in this subsection are the following: 

24 ‘‘(1) The individual is a resident of the United 

25 States. 

26 ‘‘(2) The individual is— 


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1 ‘‘(A) a citizen or national of the United 

2 States; or 

3 ‘‘(B) an alien lawfully admitted for perma4 nent residence. 

5 ‘‘(3) The individual is not otherwise entitled to 

6 benefits under part A or eligible to enroll under part 

7 A or part B. 

8 ‘‘(4) The individual has attained 50 years of 

9 age but has not attained 65 years of age. 

10 ‘‘(5) The individual is a qualified first re11 sponder (as defined in subsection (d)(2)). 

12 ‘‘(d) DEFINITIONS.—In this section: 

13 ‘‘(1) FIRST RESPONDER.—The term ‘first re14 sponder’ means— 

15 ‘‘(A) a qualified law enforcement officer 

16 (as defined in section 926B(c) of title 18, 

17 United States Code); 

18 ‘‘(B) an employee described in clause (i) of 

19 section 72(t)(10)(B) of the Internal Revenue 

20 Code of 1986; or 

21 ‘‘(C) a Federal firefighter described in sec22 tion 8331(21) or 8401(14) of title 5, United 

23 States Code. 

24 ‘‘(2) QUALIFIED FIRST RESPONDER.—The term 

25 ‘qualified first responder’ means a first responder 


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1 who is separated from service due to retirement or 

2 disability. 

3 ‘‘(e) ENROLLMENT AND COVERAGE PERIODS.— 

4 ‘‘(1) IN GENERAL.—The Secretary shall estab5 lish enrollment and coverage periods for individuals 

6 who enroll under this section. 

7 ‘‘(2) COORDINATION.—Such periods shall be es8 tablished in coordination with the enrollment and 

9 coverage periods for plans offered under an Ex10 change established under title I of the Patient Pro11 tection and Affordable Care Act and plans under 

12 parts C and D. If the Secretary determines appro13 priate, the Secretary may expand such enrollment 

14 periods beyond the enrollment periods under such an 

15 Exchange or under parts C and D. 

16 ‘‘(3) BEGINNING OF COVERAGE AND SPECIAL

17 ENROLLMENT PERIODS.—The Secretary shall estab18 lish such periods so that coverage under this section 

19 shall first begin on January 1 of the first year be20 ginning at least 1 year after the date of the enact21 ment of this section and shall include special enroll22 ment periods, in accordance with section 155.420 of 

23 title 45 of the Code of Federal Regulations, that are 

24 applicable to qualified health plans offered through 

25 an Exchange. 


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1 ‘‘(f) PREMIUM.— 

2 ‘‘(1) AMOUNT OF MONTHLY PREMIUMS.—The 

3 Secretary shall (beginning for the first year that be4 gins more than 1 year after the date of enactment 

5 of this section) determine a monthly premium for all 

6 individuals enrolled under this section. Such monthly 

premium shall be equal to 1 7 ⁄12 of the annual pre8 mium computed under paragraph (2)(B), which 

9 shall apply with respect to coverage provided under 

10 this section for any month in the succeeding year. 

11 ‘‘(2) ANNUAL PREMIUM.— 

12 ‘‘(A) COMBINED PER CAPITA AVERAGE FOR

13 ALL MEDICARE BENEFITS.—The Secretary shall 

14 estimate the average, annual per capita amount 

15 for benefits and administrative expenses that 

16 will be payable under parts A, B, and D (in17 cluding, as applicable, under part C) in the year 

18 for all individuals enrolled under this section. 

19 ‘‘(B) ANNUAL PREMIUM.—The annual pre20 mium under this subsection for months in a 

21 year is equal to the average, annual per capita 

22 amount estimated under subparagraph (A) for 

23 the year. 

24 ‘‘(3) INCREASED PREMIUM FOR CERTAIN PART

25 C AND D PLANS.—Nothing in this section shall preVerDate Sep 11 2014 03:00 Oct 25, 2023 Jkt 049200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S3113.IS S3113

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1 clude an individual from choosing a Medicare Advan2 tage plan or a prescription drug plan which requires 

3 the individual to pay an additional amount (because 

4 of supplemental benefits or because it is a more ex5 pensive plan). In such case the individual would be 

6 responsible for the increased monthly premium. 

7 ‘‘(g) PAYMENT OF PREMIUMS.— 

8 ‘‘(1) IN GENERAL.—Premiums for enrollment 

9 under this section shall be paid to the Secretary at 

10 such times, and in such manner, as the Secretary 

11 determines appropriate. 

12 ‘‘(2) DEPOSIT.—Amounts collected by the Sec13 retary under this section shall be deposited in the 

14 Federal Hospital Insurance Trust Fund and the 

15 Federal Supplementary Medical Insurance Trust 

16 Fund (including the Medicare Prescription Drug Ac17 count within such Trust Fund) in such proportion 

18 as the Secretary determines appropriate. 

19 ‘‘(h) NOT ELIGIBLE FOR MEDICARE COST-SHARING

20 ASSISTANCE.—An individual enrolled under this section 

21 shall not be treated as enrolled under any part of this title 

22 for purposes of obtaining medical assistance for Medicare 

23 cost-sharing or otherwise under title XIX. 

24 ‘‘(i) TREATMENT IN RELATION TO THE AFFORDABLE

25 CARE ACT.— 


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1 ‘‘(1) SATISFACTION OF INDIVIDUAL MAN2 DATE.—For purposes of applying section 5000A of 

3 the Internal Revenue Code of 1986, the coverage 

4 provided under this section constitutes minimum es5 sential coverage under subsection (f)(1)(A)(i) of 

6 such section 5000A. 

7 ‘‘(2) ELIGIBILITY FOR PREMIUM ASSISTANCE.— 

8 Coverage provided under this section— 

9 ‘‘(A) shall be treated as coverage under a 

10 qualified health plan in the individual market 

11 enrolled in through the Exchange where the in12 dividual resides for all purposes of section 36B 

13 of the Internal Revenue Code of 1986, other 

14 than subsection (c)(2)(B) thereof; and 

15 ‘‘(B) shall not be treated as eligibility for 

16 other minimum essential coverage for purposes 

17 of subsection (c)(2)(B) of such section 36B. 

18 ‘‘(3) SECOND LOWEST COST SILVER PLAN.— 

19 The Secretary shall determine the applicable second 

20 lowest cost silver plan which shall apply to coverage 

21 under this section for purposes of section 36B of the 

22 Internal Revenue Code of 1986. 

23 ‘‘(4) ELIGIBILITY FOR COST-SHARING SUB24 SIDIES.—For purposes of applying section 1402 of 


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1 the Patient Protection and Affordable Care Act (42 

2 U.S.C. 18071)— 

3 ‘‘(A) coverage provided under this section 

4 shall be treated as coverage under a qualified 

5 health plan in the silver level of coverage in the 

6 individual market offered through an Exchange; 

7 and 

8 ‘‘(B) the Secretary shall be treated as the 

9 issuer of such plan. 

10 ‘‘(5) MEDICAID MANAGED CARE.—States are 

11 prohibited from buying their Medicaid beneficiaries 

12 ages 50 to 64 into Medicare under this section, and 

13 individuals otherwise eligible for enrollment under a 

14 State plan under title XIX are prohibited from cov15 erage under this title pursuant to enrollment under 

16 this section. The preceding sentence shall not apply 

17 to Medicaid beneficiaries whose Medicaid coverage or 

18 eligibility does not meet the definition of minimum 

19 essential coverage under a government-sponsored 

20 program under section 1.5000A–2 of title 26, Code 

21 of Federal Regulations (or any successor regulation). 

22 ‘‘(6) COORDINATION WITH MARKET REFORMS, 

23 ETC.—Notwithstanding Treasury Notice 2015–17, 

24 no provision of law shall prevent an employer from 

25 maintaining an arrangement under which the emVerDate Sep 11 2014 03:00 Oct 25, 2023 Jkt 049200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S3113.IS S3113

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1 ployer pays or reimburses any portion of the pre2 miums for coverage under this section for retired 

3 employees of the employer, or prevent such payment 

4 or reimbursement from being excluded from the 

5 gross income of the individual enrolled in such cov6 erage for purposes of the Internal Revenue Code of 

7 1986. 

8 ‘‘(j) GUARANTEED ISSUE OF MEDIGAP POLICIES

9 UPON FIRST ENROLLMENT AND EACH SUBSEQUENT EN10 ROLLMENT.—In the case of an individual who enrolls 

11 under this section (including an individual who was pre12 viously enrolled under this section), paragraphs (2)(A), 

13 (2)(D), (3)(B)(ii), and (3)(B)(vi) of section 1882(s)— 

14 ‘‘(1) shall be applied by substituting ‘50’ for 

15 ‘65’; 

16 ‘‘(2) if the individual was enrolled under this 

17 section and subsequently disenrolls, shall apply each 

18 time the individual subsequently reenrolls under this 

19 section as if the individual had attained 50 years of 

20 age on the date of such reenrollment (and as if the 

21 individual had never previously enrolled in a Medi22 care supplemental policy); and 

23 ‘‘(3) shall be applied as if this section had not 

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1 viously enrolled in a Medicare supplemental policy) 

2 when the individual attains 65 years of age. 

3 ‘‘(k) OVERSIGHT.—There is established an advisory 

4 committee to be known as the ‘Medicare Buy In Oversight 

5 Board’ to monitor and oversee the implementation of this 

6 section, including the experience of the individuals enroll7 ing under this section. The Medicare Buy In Oversight 

8 Board shall have members that include representatives of 

9 insurers, actuaries, consumer advocacy organizations, and 

10 individuals representing the first responder community, 

11 and shall make periodic recommendations for the con12 tinual improvement of the implementation of this section 

13 as well as the relationship of enrollment under this section 

14 to other health care programs. 

15 ‘‘(l) OUTREACH AND ENROLLMENT.— 

16 ‘‘(1) IN GENERAL.—During the period that be17 gins on January 1, 2024, and ends on December 31, 

18 2026, the Secretary shall award grants to eligible 

19 entities for the following purposes: 

20 ‘‘(A) OUTREACH AND ENROLLMENT.—To 

21 carry out outreach, public education activities, 

22 and enrollment activities to raise awareness of 

23 the availability of, and encourage, enrollment 

24 under this section. 


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1 ‘‘(B) ASSISTING INDIVIDUALS’ TRANSITION

2 UNDER THIS SECTION.—To provide assistance 

3 to individuals to enroll under this section. 

4 ‘‘(C) RAISING AWARENESS OF PREMIUM

5 ASSISTANCE AND COST-SHARING REDUC6 TIONS.—To distribute fair and impartial infor7 mation concerning enrollment under this section 

8 and the availability of premium assistance tax 

9 credits under section 36B of the Internal Rev10 enue Code of 1986 and cost-sharing reductions 

11 under section 1402 of the Patient Protection 

12 and Affordable Care Act, and to assist eligible 

13 individuals in applying for such tax credits and 

14 cost-sharing reductions. 

15 ‘‘(2) ELIGIBLE ENTITIES.— 

16 ‘‘(A) IN GENERAL.—In this subsection, the 

17 term ‘eligible entity’ means— 

18 ‘‘(i) a State; 

19 ‘‘(ii) a nonprofit community-based or20 ganization; or 

21 ‘‘(iii) a nonprofit first responder orga22 nization. 

23 ‘‘(B) ENROLLMENT AGENTS.—Such term 

24 includes a licensed independent insurance agent 

25 or broker that has an arrangement with a 


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1 State, nonprofit community-based organization, 

2 or nonprofit first responder organization to en3 roll eligible individuals under this section. 

4 ‘‘(C) EXCLUSIONS.—Such term does not 

5 include an entity that— 

6 ‘‘(i) is a health insurance issuer; or 

7 ‘‘(ii) receives any consideration, either 

8 directly or indirectly, from any health in9 surance issuer in connection with the en10 rollment of any individuals under this sec11 tion. 

12 ‘‘(3) PRIORITY.—In awarding grants under this 

13 subsection, the Secretary shall give priority to 

14 awarding grants to States or eligible entities in 

15 States that have geographic rating areas at risk of 

16 having no qualified health plans in the individual 

17 market. 

18 ‘‘(4) FUNDING.—For purposes of carrying out 

19 this subsection, there is appropriated to the Sec20 retary, out of any moneys in the Treasury not other21 wise appropriated, such sums as are necessary for 

22 fiscal year 2024 and for each subsequent fiscal year. 

23 ‘‘(m) NO EFFECT ON BENEFITS FOR INDIVIDUALS

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1 retary shall implement the provisions of this section in 

2 such a manner to ensure that such provisions— 

3 ‘‘(1) have no effect on the benefits under this 

4 title for individuals who are entitled to, or enrolled 

5 for, such benefits other than through this section; 

6 and 

7 ‘‘(2) have no negative impact on the Federal 

8 Hospital Insurance Trust Fund or the Federal Sup9 plementary Medical Insurance Trust Fund (includ10 ing the Medicare Prescription Drug Account within 

11 such Trust Fund). 

12 ‘‘(n) CONSULTATION.—In promulgating regulations 

13 to implement this section, the Secretary shall consult with 

14 interested parties, including groups representing bene15 ficiaries, health care providers, employers, insurance com16 panies, and organizations representing first responders.’’. 

Æ 


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