I 

116TH CONGRESS 

1ST SESSION H. R. 4527 

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 HOUSE OF REPRESENTATIVES 

SEPTEMBER 26, 2019 

Mr. MALINOWSKI (for himself, Mr. ROUDA, Mr. CARBAJAL, and Mr. KIM) 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 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 Early Retirees 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 ‘‘MEDICARE BUY-IN OPTION FOR FIRST RESPONDERS 50

9 TO 64 YEARS OF AGE WHO ARE SEPARATED FROM

10 SERVICE DUE TO RETIREMENT OR DISABILITY

11 ‘‘SEC. 1899C. (a) OPTION.— 

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

13 the requirements described in paragraph (3) shall be 

14 eligible to enroll under this section. 

15 ‘‘(2) PART A, B, AND D BENEFITS.—An indi16 vidual enrolled under this section is entitled to the 

17 same benefits (and shall receive the same protec18 tions) under this title as an individual who is enti19 tled to benefits under part A and enrolled under 

20 parts B and D, including the ability to enroll in a 

21 Medicare Advantage plan that provides qualified pre22 scription drug coverage (an MA–PD plan). 

23 ‘‘(3) REQUIREMENTS FOR ELIGIBILITY.—The 

24 requirements described in this paragraph are the fol25 lowing: 


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1 ‘‘(A) The individual is a resident of the 

2 United States. 

3 ‘‘(B) The individual is— 

4 ‘‘(i) a citizen or national of the United 

5 States; or 

6 ‘‘(ii) an alien lawfully admitted for 

7 permanent residence. 

8 ‘‘(C) The individual is not otherwise enti9 tled to benefits under part A or eligible to en10 roll under part A or part B. 

11 ‘‘(D) The individual has attained 50 years 

12 of age but has not attained 65 years of age. 

13 ‘‘(E) The individual is a qualified first re14 sponder (as defined in paragraph (4)(B)). 

15 ‘‘(4) DEFINITIONS.—In this section: 

16 ‘‘(A) FIRST RESPONDER.—The term ‘first 

17 responder’ means— 

18 ‘‘(i) a qualified law enforcement offi19 cer (as defined in section 926B(c) of title 

20 18, United States Code); 

21 ‘‘(ii) an employee described in clause 

22 (i) of section 72(t)(10)(B) of the Internal 

23 Revenue Code of 1986 who provides fire24 fighting services or emergency medical 

25 services; or 


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1 ‘‘(iii) a Federal firefighter described 

2 in section 8331(21) or 8401(14) of title 5, 

3 United States Code. 

4 ‘‘(B) QUALIFIED FIRST RESPONDER.—The 

5 term ‘qualified first responder’ means a first re6 sponder who is separated from service due to 

7 retirement or disability. 

8 ‘‘(b) ENROLLMENT AND COVERAGE PERIODS.— 

9 ‘‘(1) IN GENERAL.—The Secretary shall estab10 lish enrollment and coverage periods for individuals 

11 who enroll under this section. 

12 ‘‘(2) COORDINATION.—Such periods shall be es13 tablished in coordination with the enrollment and 

14 coverage periods for plans offered under an Ex15 change established under title I of the Patient Pro16 tection and Affordable Care Act and plans under 

17 parts C and D. If the Secretary determines appro18 priate, the Secretary may expand such enrollment 

19 periods beyond the enrollment periods under such an 

20 Exchange or under parts C and D. 

21 ‘‘(3) BEGINNING OF COVERAGE AND SPECIAL

22 ENROLLMENT PERIODS.—The Secretary shall estab23 lish such periods so that coverage under this section 

24 shall first begin on January 1 of the first year be25 ginning at least one year after the date of the enactVerDate Sep 11 2014 04:32 Oct 02, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H4527.IH H4527

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1 ment of this section and shall include special enroll2 ment periods, in accordance with section 155.420 of 

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

4 applicable to qualified health plans offered through 

5 an Exchange. 

6 ‘‘(c) PREMIUM.— 

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

8 Secretary shall (beginning for the 1st year that be9 gins more than 1 year after the date of enactment 

10 of this section) determine a monthly premium for all 

11 individuals enrolled under this section. Such monthly 

premium shall be equal to 1 12 ⁄12 of the annual pre13 mium computed under paragraph (2)(B), which 

14 shall apply with respect to coverage provided under 

15 this section for any month in the succeeding year. 

16 ‘‘(2) ANNUAL PREMIUM.— 

17 ‘‘(A) COMBINED PER CAPITA AVERAGE FOR

18 ALL MEDICARE BENEFITS.—The Secretary shall 

19 estimate the average, annual per capita amount 

20 for benefits and administrative expenses that 

21 will be payable under parts A, B, and D (in22 cluding, as applicable, under part C) in the year 

23 for all individuals enrolled under this section. 

24 ‘‘(B) ANNUAL PREMIUM.—The annual pre25 mium under this subsection for months in a 


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1 year is equal to the average, annual per capita 

2 amount estimated under subparagraph (A) for 

3 the year. 

4 ‘‘(3) INCREASED PREMIUM FOR CERTAIN PART

5 C AND D PLANS.—Nothing in this section shall pre6 clude an individual from choosing a Medicare Advan7 tage plan or a prescription drug plan which requires 

8 the individual to pay an additional amount (because 

9 of supplemental benefits or because it is a more ex10 pensive plan). In such case the individual would be 

11 responsible for the increased monthly premium. 

12 ‘‘(d) PAYMENT OF PREMIUMS.— 

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

14 under this section shall be paid to the Secretary at 

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

16 determines appropriate. 

17 ‘‘(2) DEPOSIT.—Amounts collected by the Sec18 retary under this section shall be deposited in the 

19 Federal Hospital Insurance Trust Fund and the 

20 Federal Supplementary Medical Insurance Trust 

21 Fund (including the Medicare Prescription Drug Ac22 count within such Trust Fund) in such proportion 

23 as the Secretary determines appropriate. 

24 ‘‘(e) NOT ELIGIBLE FOR MEDICARE COST-SHARING

25 ASSISTANCE.—An individual enrolled under this section 


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

2 for purposes of obtaining medical assistance for Medicare 

3 cost-sharing or otherwise under title XIX. 

4 ‘‘(f) TREATMENT IN RELATION TO THE AFFORDABLE

5 CARE ACT.— 

6 ‘‘(1) SATISFACTION OF INDIVIDUAL MAN7 DATE.—For purposes of applying section 5000A of 

8 the Internal Revenue Code of 1986, the coverage 

9 provided under this section constitutes minimum es10 sential coverage under subsection (f)(1)(A)(i) of 

11 such section 5000A. 

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

13 Coverage provided under this section— 

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

15 qualified health plan in the individual market 

16 enrolled in through the Exchange where the in17 dividual resides for all purposes of section 36B 

18 of the Internal Revenue Code of 1986 other 

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

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

21 other minimum essential coverage for purposes 

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

23 The Secretary shall determine the applicable second 

24 lowest cost silver plan which shall apply to coverage 


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1 under this section for purposes of section 36B of 

2 such Code. 

3 ‘‘(3) ELIGIBILITY FOR COST-SHARING SUB4 SIDIES.—For purposes of applying section 1402 of 

5 the Patient Protection and Affordable Care Act (42 

6 U.S.C. 18071)— 

7 ‘‘(A) coverage provided under this section 

8 shall be treated as coverage under a qualified 

9 health plan in the silver level of coverage in the 

10 individual market offered through an Exchange; 

11 and 

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

13 issuer of such plan. 

14 ‘‘(4) MEDICAID MANAGED CARE.—States are 

15 prohibited from buying their Medicaid beneficiaries 

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

17 individuals otherwise eligible for enrollment under a 

18 State plan under title XIX are prohibited from cov19 erage under this title pursuant to enrollment under 

20 this section. The preceding sentence shall not apply 

21 to Medicaid beneficiaries whose Medicaid coverage or 

22 eligibility does not meet the definition of minimum 

23 essential coverage under a government-sponsored 

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

25 of Federal Regulations (or any successor regulation). 


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1 ‘‘(5) COORDINATION WITH MARKET REFORMS, 

2 ETC.—Notwithstanding Treasury Notice 2015–17, 

3 no provision of law shall prevent an employer from 

4 maintaining an arrangement under which the em5 ployer pays or reimburses any portion of the pre6 miums for coverage under this section for retired 

7 employees of the employer, or prevent such payment 

8 or reimbursement from being excluded from the 

9 gross income of the individual enrolled in such cov10 erage for purposes of the Internal Revenue Code of 

11 1986. 

12 ‘‘(g) GUARANTEED ISSUE OF MEDIGAP POLICIES

13 UPON FIRST ENROLLMENT AND EACH SUBSEQUENT EN14 ROLLMENT.—In the case of an individual who enrolls 

15 under this section (including an individual who was pre16 viously enrolled under this section), paragraphs (2)(A), 

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

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

19 ‘65’; 

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

21 section and subsequently disenrolls, shall apply each 

22 time the individual subsequently reenrolls under this 

23 section as if the individual had attained 50 years of 

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


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1 individual had never previously enrolled in a Medi2 care supplemental policy); and 

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

4 been enacted (and as if the individual had never pre5 viously enrolled in a Medicare supplemental policy) 

6 when the individual attains 65 years of age. 

7 ‘‘(h) OVERSIGHT.—There is established an advisory 

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

9 Board’ to monitor and oversee the implementation of this 

10 section, including the experience of the individuals enroll11 ing under this section. The Medicare Buy In Oversight 

12 Board shall have members that include representatives of 

13 insurers, actuaries, consumer advocacy organizations, and 

14 individuals representing the first responder community, 

15 and shall make periodic recommendations for the con16 tinual improvement of the implementation of this section 

17 as well as the relationship of enrollment under this section 

18 to other health care programs. 

19 ‘‘(i) OUTREACH AND ENROLLMENT.— 

20 ‘‘(1) IN GENERAL.—During the period that be21 gins on January 1, 2020, and ends on December 31, 

22 2022, the Secretary shall award grants to eligible 

23 entities for the following purposes: 

24 ‘‘(A) OUTREACH AND ENROLLMENT.—To 

25 carry out outreach, public education activities, 


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1 and enrollment activities to raise awareness of 

2 the availability of, and encourage, enrollment 

3 under this section. 

4 ‘‘(B) ASSISTING INDIVIDUALS’ TRANSITION

5 UNDER THIS SECTION.—To provide assistance 

6 to individuals to enroll under this section. 

7 ‘‘(C) RAISING AWARENESS OF PREMIUM

8 ASSISTANCE AND COST-SHARING REDUC9 TIONS.—To distribute fair and impartial infor10 mation concerning enrollment under this section 

11 and the availability of premium assistance tax 

12 credits under section 36B of the Internal Rev13 enue Code of 1986 and cost-sharing reductions 

14 under section 1402 of the Patient Protection 

15 and Affordable Care Act, and to assist eligible 

16 individuals in applying for such tax credits and 

17 cost-sharing reductions. 

18 ‘‘(2) ELIGIBLE ENTITIES.— 

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

20 term ‘eligible entity’ means— 

21 ‘‘(i) a State; 

22 ‘‘(ii) a nonprofit community-based or23 ganization; or 

24 ‘‘(iii) a nonprofit first responder orga25 nization. 


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1 ‘‘(B) ENROLLMENT AGENTS.—Such term 

2 includes a licensed independent insurance agent 

3 or broker that has an arrangement with a 

4 State, nonprofit community-based organization, 

5 or nonprofit first responder organization to en6 roll eligible individuals under this section. 

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

8 include an entity that— 

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

10 ‘‘(ii) receives any consideration, either 

11 directly or indirectly, from any health in12 surance issuer in connection with the en13 rollment of any individuals under this sec14 tion. 

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

16 subsection, the Secretary shall give priority to 

17 awarding grants to States or eligible entities in 

18 States that have geographic rating areas at risk of 

19 having no qualified health plans in the individual 

20 market. 

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

22 this subsection, there is appropriated to the Sec23 retary, out of any moneys in the Treasury not other24 wise appropriated, such sums as are necessary for 


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1 calendar year 2020 and for each subsequent cal2 endar year. 

3 ‘‘(j) NO EFFECT ON BENEFITS FOR INDIVIDUALS

4 OTHERWISE ELIGIBLE OR ON TRUST FUNDS.—The Sec5 retary shall implement the provisions of this section in 

6 such a manner to ensure that such provisions— 

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

8 title for individuals who are entitled to, or enrolled 

9 for, such benefits other than through this section; 

10 and 

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

12 Hospital Insurance Trust Fund or the Federal Sup13 plementary Medical Insurance Trust Fund (includ14 ing the Medicare Prescription Drug Account within 

15 such Trust Fund). 

16 ‘‘(k) CONSULTATION.—In promulgating regulations 

17 to implement this section, the Secretary shall consult with 

18 interested parties, including groups representing bene19 ficiaries, health care providers, employers, insurance com20 panies, and organizations representing first responders.’’. 

Æ 


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