I 

112TH CONGRESS 

1ST SESSION H. R. 1654 

To amend title XVIII of the Social Security Act to provide for additional 

opportunities to enroll under part B of the Medicare Program, and 

for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 15, 2011 

Mr. SCHRADER (for himself, Mr. KISSELL, Mr. LARSON of Connecticut, Ms. 

BALDWIN, Mr. KUCINICH, and Mr. FARR) introduced the following bill; 

which was referred to the Committee on Energy and Commerce, and in 

addition to the Committee on Ways and Means, 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 title XVIII of the Social Security Act to provide 

for additional opportunities to enroll under part B of 

the Medicare Program, and for other purposes. 

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 ‘‘Medicare Enrollment 

5 Protection Act of 2011’’. 


smartinez on DSKB9S0YB1PROD with BILLS
2 

•HR 1654 IH

1 SEC. 2. MEDICARE PART B SPECIAL ENROLLMENT PERIOD 

2 FOR INDIVIDUALS ENROLLED IN COBRA CON3 TINUATION COVERAGE. 

4 (a) SPECIAL ENROLLMENT PERIOD.—Section 

5 1837(i) of the Social Security Act (42 U.S.C. 1395p(i)) 

6 is amended by adding at the end the following new para7 graph: 

8 ‘‘(5)(A) In the case of an individual who— 

9 ‘‘(i) at the time the individual first satisfies 

10 paragraph (1) or (2) of section 1836, is enrolled in 

11 COBRA continuation coverage (as defined in sub12 paragraph (D)), and 

13 ‘‘(ii) has elected not to enroll (or to be deemed 

14 enrolled) under this section during the individual’s 

15 initial enrollment period, 

16 there shall be a special enrollment period described 

17 in subparagraph (B). 

18 ‘‘(B) The special enrollment period referred to in sub19 paragraph (A) is the period including each month during 

20 any part of which the individual is enrolled in COBRA 

21 continuation coverage ending with the last day of the 

22 eighth consecutive month in which the individual is at no 

23 time so enrolled. 

24 ‘‘(C) An individual may only enroll during the special 

25 enrollment period provided under subparagraph (B) one 

26 time during the individual’s lifetime. 


smartinez on DSKB9S0YB1PROD with BILLS
3 

•HR 1654 IH

1 ‘‘(D) For purposes of this paragraph, the term 

2 ‘COBRA continuation coverage’ means continuation cov3 erage provided pursuant to part 6 of subtitle B of title 

4 I of the Employee Retirement Income Security Act of 

5 1974 (other than under section 609), title XXII of the 

6 Public Health Service Act, section 4980B of the Internal 

7 Revenue Code of 1986 (other than subsection (f)(1) of 

8 such section insofar as it relates to pediatric vaccines), or 

9 section 8905a of title 5, United States Code, or under a 

10 State program that provides comparable continuation cov11 erage. Such term does not include coverage under a health 

12 flexible spending arrangement under a cafeteria plan with13 in the meaning of section 125 of the Internal Revenue 

14 Code of 1986.’’. 

15 (b) COVERAGE PERIOD.—Section 1838(e) of such 

16 Act (42 U.S.C. 1395q(e)) is amended— 

17 (1) by striking ‘‘pursuant to section 1837(i)(3) 

18 or 1837(i)(4)(B)’’ and inserting the following: 

19 ‘‘pursuant to— 

20 ‘‘(1) section 1837(i)(3) or 1837(i)(4)(B)—’’; 

21 (2) by redesignating paragraphs (1) and (2) as 

22 subparagraphs (A) and (B), respectively, and mov23 ing the indentation of each such subparagraph 2 

24 ems to the right; 


smartinez on DSKB9S0YB1PROD with BILLS
4 

•HR 1654 IH

1 (3) by striking the period at the end of the sub2 paragraph (B), as so redesignated, and inserting ‘‘; 

3 or’’; and 

4 (4) by adding at the end the following new 

5 paragraph: 

6 ‘‘(2) section 1837(i)(5), the coverage period 

7 shall begin on the first day of the month following 

8 the month in which the individual so enrolls.’’. 

9 (c) NO INCREASE IN PREMIUM.—Section 1839(b) of 

10 such Act (42 U.S.C. 1395r(b)) is amended— 

11 (1) in the first sentence, by inserting ‘‘, (i)(5),’’ 

12 after ‘‘subsection (i)(4)’’; and 

13 (2) in the second sentence, by inserting before 

14 the period at the end the following: ‘‘or months for 

15 which the individual can demonstrate that the indi16 vidual was enrolled in COBRA continuation coverage 

17 (as such term is defined in section 1837(i)(5)(D)).’’. 

18 (d) EFFECTIVE DATE.— 

19 (1) IN GENERAL.—The amendments made by 

20 this section shall take effect on the date of the en21 actment of this Act and shall apply to periods of 

22 COBRA continuation coverage before, on, or after 

23 such date. 

24 (2) SPECIAL ENROLLMENT PERIOD.—No spe25 cial enrollment period under section 1837(i)(5)(B) of 


smartinez on DSKB9S0YB1PROD with BILLS
5 

•HR 1654 IH

1 the Social Security Act (42 U.S.C. 1395p(i)(5)(B)) 

2 shall begin before the first day of the first month 

3 that begins at least 45 days after the date of the en4 actment of this Act. 

5 (3) PREMIUMS.—The amendment made by sub6 section (c)(2) shall apply to premiums for months 

7 beginning with the first month that begins at least 

8 45 days after the date of the enactment of this Act. 

9 SEC. 3. CONTINUOUS OPEN MEDICARE PART B ENROLL10 MENT. 

11 (a) CONTINUOUS OPEN ENROLLMENT PERIOD.— 

12 Section 1837 of the Social Security Act (42 U.S.C. 1395p) 

13 is amended by adding at the end the following new sub14 section: 

15 ‘‘(m)(1) There shall be a continuous open enrollment 

16 period beginning on the first day of the first month in 

17 which an individual first satisfies paragraph (1) or (2) of 

18 section 1836, except that such continuous open enrollment 

19 period shall not be available during the individual’s initial 

20 enrollment period or a special enrollment period available 

21 to the individual. 

22 ‘‘(2) In the case of an individual seeking enrollment 

23 under paragraph (1) during a general enrollment period 

24 under subsection (e), the individual shall be enrolled under 


smartinez on DSKB9S0YB1PROD with BILLS
6 

•HR 1654 IH

1 such subsection and not under paragraph (1), unless the 

2 individual specifies otherwise.’’. 

3 (b) COVERAGE PERIOD.—Section 1838(a)(2) of such 

4 Act (42 U.S.C. 1395q(a)(2)) is amended— 

5 (1) in subparagraph (E), by striking the semi6 colon and inserting a comma; and 

7 (2) by adding at the end the following new sub8 paragraph: 

9 ‘‘(F) in the case of an individual who enrolls 

10 pursuant to subsection (m) of section 1837, the first 

11 day of the month following the month in which such 

12 individual so enrolls; or’’. 

13 (c) PREMIUM INCREASE.—Section 1839 of such Act 

14 (42 U.S.C. 1395r) is amended by adding at the end the 

15 following new subsection: 

16 ‘‘(j) INCREASE IN PREMIUM BASED ON ENROLL17 MENT PURSUANT TO CONTINUOUS OPEN ENROLLMENT

18 PERIOD.—In the case of an individual whose coverage pe19 riod began pursuant to a continuous open enrollment pe20 riod under section 1837(m), the monthly premium deter21 mined under subsection (a), adjusted in accordance with 

22 subsection (i), shall, in addition to the increase required 

23 by subsection (b), be increased by such amount as the Sec24 retary considers appropriate, taking into account any ad25 ditional actuarial cost to the insurance program estabVerDate Mar 15 2010 23:42 Apr 21, 2011 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H1654.IH H1654

smartinez on DSKB9S0YB1PROD with BILLS
7 

•HR 1654 IH

1 lished under this part due to enrollment under such sec2 tion. Any increase under this subsection shall apply to all 

3 premiums paid by the individual after enrollment pursuant 

4 to such continuous open enrollment period.’’. 

5 (d) REPORT TO CONGRESS.—Not later than 180 days 

6 after the date of the enactment of this Act, the Secretary 

7 of Health and Human Services shall submit to Congress 

8 a report describing— 

9 (1) the average increase in premiums based on 

10 enrollment in the insurance program established 

11 under part B of title XVIII of the Social Security 

12 Act pursuant to a continuous open enrollment period 

13 under section 1837(m) of such Act, as added by sub14 section (a); 

15 (2) any other regulations promulgated by the 

16 Secretary with respect to such enrollment; 

17 (3) the number and characteristics of individ18 uals choosing such enrollment; and 

19 (4) any costs of such enrollment to such insur20 ance program that were not covered by the increases 

21 in premiums described in the amendment made by 

22 subsection (c). 

23 (e) EFFECTIVE DATE.—The amendments made by 

24 this section shall take effect on the date of the enactment 

25 of this Act, except that no individual may enroll pursuant 


smartinez on DSKB9S0YB1PROD with BILLS
8 

•HR 1654 IH

1 to a continuous open enrollment period under the amend2 ment made by subsection (a) before the first day of the 

3 first month that begins at least 45 days after the date 

4 of the enactment of this Act. 

5 SEC. 4. SPECIAL ENROLLMENT PERIODS TO CORRECT 

6 ERROR, MISREPRESENTATION, OR INACTION 

7 OF FEDERAL GOVERNMENT, GROUP HEALTH 

8 PLAN, OR PLAN SPONSOR. 

9 Section 1837(h) of the Social Security Act (42 U.S.C. 

10 1395p(h)) is amended by inserting ‘‘or by an officer, em11 ployee, or agent of a group health plan, or of a plan spon12 sor (as such term is defined in section 3(16)(B) of the 

13 Employee Retirement Income Security Act of 1974 (29 

14 U.S.C. 1002(16)(B))) of a group health plan,’’ after ‘‘in15 strumentalities,’’. 

16 SEC. 5. COORDINATION OF MEDICARE PART B WITH AMER17 ICAN HEALTH BENEFIT EXCHANGES. 

18 Section 1837 of the Social Security Act (42 U.S.C. 

19 1395p), as amended by section 3(a), is further amended 

20 by adding at the end the following new subsection: 

21 ‘‘(n) The Secretary shall ensure appropriate coordi22 nation between the insurance program established under 

23 this part and American Health Benefit Exchanges estab24 lished under section 1311(b) of the Patient Protection and 

25 Affordable Care Act (Public Law 111–148), including enVerDate Mar 15 2010 23:42 Apr 21, 2011 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H1654.IH H1654

smartinez on DSKB9S0YB1PROD with BILLS
9 

•HR 1654 IH

1 suring a smooth transition in enrollment from enrollment 

2 in qualified health plans offered through Exchanges to en3 rollment under this part.’’. 

4 SEC. 6. GAO STUDY AND REPORT ON MEDICARE PART B EN5 ROLLMENT. 

6 Not later than 2 years after the date of the enact7 ment of this Act, the Comptroller General of the United 

8 States shall submit to Congress a report on enrollment 

9 in the insurance program established under part B of title 

10 XVIII of the Social Security Act (in this section referred 

11 to as ‘‘Medicare part B’’). The report shall include— 

12 (1) a comprehensive evaluation of problems ex13 perienced by individuals with respect to enrollment 

14 in Medicare part B, including the causes of such 

15 problems and any geographic trends in the mani16 festation of such problems; 

17 (2) an assessment of the number of people who 

18 lack health insurance coverage because of such prob19 lems; 

20 (3) an evaluation of efforts by the Centers for 

21 Medicare & Medicaid Services and the Social Secu22 rity Administration to educate employers regarding 

23 the transition of employees from group health plans 

24 to Medicare part B; 


smartinez on DSKB9S0YB1PROD with BILLS
10 

•HR 1654 IH

1 (4) an evaluation of coordination of coverage 

2 for individuals with private health insurance who are 

3 also eligible for Medicare part B and ways to im4 prove such coordination; 

5 (5) an evaluation of the coordination between 

6 Medicare part B and American Health Benefit Ex7 changes required by the amendment made by section 

8 5; 

9 (6) an evaluation of the differences in regula10 tions applicable to individuals who are eligible for 

11 Medicare part B based on age and individuals who 

12 are eligible based on disability, and ways to improve 

13 parity in the treatment of each such group of indi14 viduals that may be implemented in regulations and 

15 guidance; and 

16 (7) an evaluation of efforts by the Centers for 

17 Medicare & Medicaid Services to provide equitable 

18 relief to individuals who suffered adverse con19 sequences due to misinformation or a lack of infor20 mation on enrollment in Medicare part B, and ways 

21 to improve the provision of such equitable relief. 

Æ 


smartinez on DSKB9S0YB1PROD with BILLS