I 

108TH CONGRESS 

2D SESSION H. R. 4357

To amend title XVIII of the Social Security Act and the Employee Retirement 

Income Security Act of 1974 to provide access to Medicare benefits 

for individuals ages 55 to 65, to amend the Internal Revenue Code 

of 1986 to allow a refundable and advanceable credit against income 

tax for payment of such premiums, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 12, 2004

Mr. STARK (for himself, Mr. BROWN of Ohio, Mr. RANGEL, Mr. DINGELL, 

Mr. WAXMAN, Ms. PELOSI, Mr. GEORGE MILLER of California, Mr. 

PALLONE, Mr. ACKERMAN, Mr. ALEXANDER, Mr. ALLEN, Mr. BACA, Mr. 

BERRY, Mr. BISHOP of New York, Mr. BOUCHER, Mrs. CAPPS, Mr. 

CARDIN, Ms. CARSON of Indiana, Mr. CLAY, Mr. CROWLEY, Mrs. DAVIS

of California, Ms. DELAURO, Mr. DELAHUNT, Mr. DEUTSCH, Mr. EMANUEL, Mr. ENGEL, Mr. EVANS, Mr. FARR, Mr. FILNER, Mr. FRANK of 

Massachusetts, Mr. FROST, Mr. GEPHARDT, Mr. GORDON, Mr. GREEN

of Texas, Mr. GRIJALVA, Mr. GUTIERREZ, Mr. HINCHEY, Mr. HOEFFEL, 

Mr. HOLT, Mr. HOYER, Mr. JACKSON of Illinois, Mrs. JONES of Ohio, 

Ms. KAPTUR, Mr. KILDEE, Ms. KILPATRICK, Mr. KLECZKA, Mr. 

KUCINICH, Mr. LANTOS, Ms. JACKSON-LEE of Texas, Mr. LYNCH, Mrs. 

MALONEY, Mr. MARKEY, Mr. MATSUI, Mrs. MCCARTHY of New York, 

Ms. MCCARTHY of Missouri, Mr. MCDERMOTT, Mr. MCGOVERN, Mr. 

MCNULTY, Mr. MEEKS of New York, Mr. MENENDEZ, Mr. MICHAUD, 

Mr. NADLER, Mrs. NAPOLITANO, Mr. OLVER, Mr. OWENS, Mr. PASTOR, 

Mr. RODRIGUEZ, Ms. ROYBAL-ALLARD, Mr. SANDERS, Mr. SANDLIN, Ms. 

LINDA T. SA ́NCHEZ of California, Ms. SCHAKOWSKY, Mr. SCOTT of Virginia, Mr. SERRANO, Ms. SLAUGHTER, Ms. SOLIS, Mr. STRICKLAND, Mr. 

STUPAK, Mr. THOMPSON of Mississippi, Mr. TIERNEY, Mr. TOWNS, Mr. 

VAN HOLLEN, Ms. WATERS, Mr. WEINER, Mr. WEXLER, and Ms. WOOLSEY) introduced the following bill; which was referred to the Committee 

on Ways and Means, and in addition to the Committees on Energy and 

Commerce and Education and the Workforce, 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 
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A BILL

To amend title XVIII of the Social Security Act and the 

Employee Retirement Income Security Act of 1974 to 

provide access to Medicare benefits for individuals ages 

55 to 65, to amend the Internal Revenue Code of 1986 

to allow a refundable and advanceable credit against 

income tax for payment of such premiums, 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; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Medicare Early Access Act of 2004’’. 

6 (b) TABLE OF CONTENTS.—

Sec. 1. Short title; table of contents. 

TITLE I—ACCESS TO MEDICARE BENEFITS FOR INDIVIDUALS 55 

TO 65 YEARS OF AGE 

Sec. 101. Access to Medicare benefits for individuals 55 to 65 years of age. 

‘‘PART E—PURCHASE OF MEDICARE BENEFITS BY CERTAIN INDIVIDUALS 55 

TO 65 YEARS OF AGE

‘‘Sec. 1860E–1. Program benefits; eligibility. 

‘‘Sec. 1860E–2. Enrollment process; coverage. 

‘‘Sec. 1860E–3. Premiums. 

‘‘Sec. 1860E–4. Payment of premiums. 

‘‘Sec. 1860E–5. Provisions relating to employment-based retiree health coverage. 

‘‘Sec. 1860E–6. Medicare Early Access Trust Fund. 

‘‘Sec. 1860E–7. Oversight and accountability. 

‘‘Sec. 1860E–8. Administration and miscellaneous. 

TITLE II—REFUNDABLE AND ADVANCEABLE CREDIT AGAINST 

INCOME TAX FOR MEDICARE BUY-IN PREMIUMS 

Sec. 201. Refundable and advanceable income tax credit for Medicare buy-in 

premiums. 

‘‘Sec. 36. Medicare buy-in premiums. 

‘‘Sec. 7528. Advance payment of credit for Medicare buy-in premiums.
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1 TITLE I—ACCESS TO MEDICARE 

2 BENEFITS FOR INDIVIDUALS 

3 55 TO 65 YEARS OF AGE 

4 SEC. 101. ACCESS TO MEDICARE BENEFITS FOR INDIVID5 UALS 55 TO 65 YEARS OF AGE. 

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

7 Act, as amended by section 101(a) of the Medicare Pre8 scription Drug, Improvement, and Modernization Act of 

9 2003 (Public Law 108–173), is amended—

10 (1) by redesignating part E as part F; and 

11 (2) by inserting after part D the following new 

12 part: 

13 ‘‘PART E—PURCHASE OF MEDICARE BENEFITS 

14 BY CERTAIN INDIVIDUALS 55 TO 65 YEARS OF 

15 AGE 

16 ‘‘SEC. 1860E–1. PROGRAM BENEFITS; ELIGIBILITY. 

17 ‘‘(a) ENTITLEMENT TO MEDICARE BENEFITS FOR

18 ENROLLED INDIVIDUALS.—

19 ‘‘(1) IN GENERAL.—An individual enrolled 

20 under this part is entitled to the same benefits 

21 under this title as an individual entitled to benefits 

22 or enrolled under any part of this title. 

23 ‘‘(2) DEFINITIONS.—For purposes of this part: 

24 ‘‘(A) FEDERAL OR STATE COBRA CONTINU25 ATION PROVISION.—The term ‘Federal or State 
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1 COBRA continuation provision’ has the mean2 ing given the term ‘COBRA continuation provi3 sion’ in section 2791(d)(4) of the Public Health 

4 Service Act and includes a comparable State 

5 program, as determined by the Secretary. 

6 ‘‘(B) FEDERAL HEALTH INSURANCE PRO7 GRAM DEFINED.—The term ‘Federal health in8 surance program’ means any of the following: 

9 ‘‘(i) MEDICARE.—Any part of this 

10 title (other than by reason of this part). 

11 ‘‘(ii) MEDICAID.—A State plan under 

12 title XIX. 

13 ‘‘(iii) FEHBP.—The Federal employ14 ees health benefit program under chapter 

15 89 of title 5, United States Code. 

16 ‘‘(iv) TRICARE.—The TRICARE 

17 program (as defined in section 1072(7) of 

18 title 10, United States Code). 

19 ‘‘(v) ACTIVE DUTY MILITARY.—Health 

20 benefits under title 10, United States 

21 Code, to an individual as a member of the 

22 uniformed services of the United States. 

23 ‘‘(C) GROUP HEALTH PLAN.—The term 

24 ‘group health plan’ has the meaning given such
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1 term in section 2791(a)(1) of the Public Health 

2 Service Act. 

3 ‘‘(b) ELIGIBILITY OF INDIVIDUALS AGE 55 TO 65 

4 YEARS OF AGE.—

5 ‘‘(1) IN GENERAL.—Subject to paragraph (2), 

6 an individual who meets the following requirements 

7 with respect to a month is eligible to enroll under 

8 this part with respect to such month: 

9 ‘‘(A) AGE.—As of the last day of the 

10 month, the individual has attained 55 years of 

11 age, but has not attained 65 years of age. 

12 ‘‘(B) MEDICARE ELIGIBILITY (BUT FOR

13 AGE).—The individual would be eligible for ben14 efits under part A or part B for the month if 

15 the individual were 65 years of age. 

16 ‘‘(C) NOT ELIGIBLE FOR COVERAGE

17 UNDER GROUP HEALTH PLANS OR FEDERAL

18 HEALTH INSURANCE PROGRAMS.—The indi19 vidual is not eligible for benefits or coverage 

20 under a Federal health insurance program (as 

21 defined in subsection (a)(2)(B)) or under a 

22 group health plan (other than such eligibility 

23 merely through a Federal or State COBRA con24 tinuation provision) as of the last day of the 

25 month involved. 
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1 ‘‘(2) LIMITATION ON ELIGIBILITY IF TERMI2 NATED ENROLLMENT.—If an individual described in 

3 paragraph (1) enrolls under this part and coverage 

4 of the individual is terminated under section 1860E–

5 2(d) (other than because of age), the individual is 

6 not again eligible to enroll under this subsection un7 less the following requirements are met: 

8 ‘‘(A) NEW COVERAGE UNDER GROUP

9 HEALTH PLAN OR FEDERAL HEALTH INSUR10 ANCE PROGRAM.—After the date of termination 

11 of coverage under such section, the individual 

12 obtains coverage under a group health plan or 

13 under a Federal health insurance program. 

14 ‘‘(B) SUBSEQUENT LOSS OF NEW COV15 ERAGE.—The individual subsequently loses eli16 gibility for the coverage described in subpara17 graph (A) without regard to whether the indi18 vidual has exhausted any eligibility the indi19 vidual may subsequently have for coverage 

20 under a Federal or State COBRA continuation 

21 provision. 

22 ‘‘(3) CHANGE IN HEALTH PLAN ELIGIBILITY

23 DOES NOT AFFECT COVERAGE.—In the case of an 

24 individual who is eligible for and enrolls under this 

25 part under this subsection, the individual’s continued 
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1 entitlement to benefits under this part shall not be 

2 affected by the individual’s subsequent eligibility for 

3 benefits or coverage described in paragraph (1)(C), 

4 or entitlement to such benefits or coverage. 

5 ‘‘SEC. 1860E–2. ENROLLMENT PROCESS; COVERAGE. 

6 ‘‘(a) IN GENERAL.—An individual may enroll in the 

7 program established under this part only in such manner 

8 and form as may be prescribed by regulations, and only 

9 during an enrollment period prescribed by the Secretary 

10 consistent with the provisions of this section. Such regula11 tions shall provide a process under which individuals eligi12 ble to enroll as of a month are permitted to pre-enroll dur13 ing a prior month within an enrollment period described 

14 in subsection (b). 

15 ‘‘(b) ENROLLMENT PERIODS.—

16 ‘‘(1) INDIVIDUALS 55 TO 65 YEARS OF AGE.—In 

17 the case of individuals eligible to enroll under this 

18 part under section 1860E–1(b)—

19 ‘‘(A) INITIAL ENROLLMENT PERIOD.—If 

20 the individual is eligible to enroll under such 

21 section for January 2005, the enrollment period 

22 shall begin on November 1, 2004, and shall end 

23 on February 28, 2005. Any such enrollment be24 fore January 1, 2005, is conditioned upon com-
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1 pliance with the conditions of eligibility for Jan2 uary 2005. 

3 ‘‘(B) SUBSEQUENT PERIODS.—If the indi4 vidual is eligible to enroll under such section for 

5 a month after January 2005, the enrollment pe6 riod shall begin on the first day of the second 

7 month before the month in which the individual 

8 first is eligible to so enroll and shall end four 

9 months later. Any such enrollment before the 

10 first day of the third month of such enrollment 

11 period is conditioned upon compliance with the 

12 conditions of eligibility for such third month. 

13 ‘‘(2) AUTHORITY TO CORRECT FOR GOVERN14 MENT ERRORS.—The provisions of section 1837(h) 

15 apply with respect to enrollment under this part in 

16 the same manner as they apply to enrollment under 

17 part B. 

18 ‘‘(c) DATE COVERAGE BEGINS.—

19 ‘‘(1) IN GENERAL.—The period during which 

20 an individual is entitled to benefits under this part 

21 shall begin as follows, but in no case earlier than 

22 January 1, 2005: 

23 ‘‘(A) In the case of an individual who en24 rolls (including pre-enrolls) before the month in 

25 which the individual satisfies eligibility for en-
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1 rollment under section 1860E–1, the first day 

2 of such month of eligibility. 

3 ‘‘(B) In the case of an individual who en4 rolls during or after the month in which the in5 dividual first satisfies eligibility for enrollment 

6 under such section, the first day of the fol7 lowing month. 

8 ‘‘(2) AUTHORITY TO PROVIDE FOR PARTIAL

9 MONTHS OF COVERAGE.—Under regulations, the 

10 Secretary may, in the Secretary’s discretion, provide 

11 for coverage periods that include portions of a 

12 month in order to avoid lapses of coverage. 

13 ‘‘(3) LIMITATION ON PAYMENTS.—No payments 

14 may be made under this title with respect to the ex15 penses of an individual enrolled under this part un16 less such expenses were incurred by such individual 

17 during a period which, with respect to the individual, 

18 is a coverage period under this section. 

19 ‘‘(d) TERMINATION OF COVERAGE.—

20 ‘‘(1) IN GENERAL.—An individual’s coverage 

21 period under this part shall continue until the indi22 vidual’s enrollment has been terminated at the ear23 liest of the following: 

24 ‘‘(A) GENERAL PROVISIONS.—
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1 ‘‘(i) NOTICE.—The individual files no2 tice (in a form and manner prescribed by 

3 the Secretary) that the individual no 

4 longer wishes to participate in the insur5 ance program under this part. 

6 ‘‘(ii) NONPAYMENT OF PREMIUMS.—

7 The individual fails to make payment of 

8 premiums required for enrollment under 

9 this part. 

10 ‘‘(iii) MEDICARE ELIGIBILITY.—The 

11 individual becomes entitled to benefits or 

12 enrolled under any other part of this title 

13 (other than by reason of this part). 

14 ‘‘(B) TERMINATION BASED ON AGE.—The 

15 individual attains 65 years of age. 

16 ‘‘(2) EFFECTIVE DATE OF TERMINATION.—

17 ‘‘(A) NOTICE.—The termination of a cov18 erage period under paragraph (1)(A)(i) shall 

19 take effect at the close of the month following 

20 for which the notice is filed. 

21 ‘‘(B) NONPAYMENT OF PREMIUM.—The 

22 termination of a coverage period under para23 graph (1)(A)(ii) shall take effect on a date de24 termined under regulations, which may be de25 termined so as to provide a grace period in 
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1 which overdue premiums may be paid and cov2 erage continued. The grace period determined 

3 under the preceding sentence shall not exceed 

4 60 days; except that it may be extended for an 

5 additional 30 days in any case where the Sec6 retary determines that there was good cause for 

7 failure to pay the overdue premiums within 

8 such 60-day period. 

9 ‘‘(C) AGE OR MEDICARE ELIGIBILITY.—

10 The termination of a coverage period under 

11 paragraph (1)(A)(iii) or (1)(B) shall take effect 

12 as of the first day of the month in which the 

13 individual attains 65 years of age or becomes 

14 entitled to benefits or enrolled in any other part 

15 of this title (other than by reason of this part). 

16 ‘‘SEC. 1860E–3. PREMIUMS. 

17 ‘‘(a) AMOUNT OF MONTHLY PREMIUMS.—The Sec18 retary shall, during September of each year (beginning 

19 with 2004), determine a monthly premium for individuals 

55 years of age or older, equal to 1 20 ⁄12 of the annual pre21 mium computed under subsection (b)(2), which shall apply 

22 with respect to coverage provided under this title for any 

23 month in the succeeding year. 

24 ‘‘(b) ANNUAL PREMIUM.—
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1 ‘‘(1) NATIONAL, PER CAPITA AVERAGE.—The 

2 Secretary shall estimate the average, annual per 

3 capita amount that would be payable under this title 

4 with respect to individuals residing in the United 

5 States who meet the requirement of section 1860E–

6 1(b)(1)(A) as if all such individuals were eligible for 

7 (and enrolled) under this title during the entire year 

8 (and assuming that section 1862(b)(2)(A)(i) did not 

9 apply). 

10 ‘‘(2) ANNUAL PREMIUM.—The annual premium 

11 under this subsection for months in a year is equal 

12 to the average, annual per capita amount estimated 

13 under paragraph (1) for the year. 

14 ‘‘SEC. 1860E–4. PAYMENT OF PREMIUMS. 

15 ‘‘(a) PAYMENT OF MONTHLY PREMIUM.—

16 ‘‘(1) IN GENERAL.—The Secretary shall provide 

17 for payment and collection of the monthly premium, 

18 determined under section 1860E–3(a) for the age of 

19 the individual involved, in the same manner as for 

20 payment of monthly premiums under section 1840, 

21 except that, for purposes of applying this section, 

22 any reference in such section to the Federal Supple23 mentary Medical Insurance Trust Fund is deemed a 

24 reference to the Trust Fund established under sec25 tion 1860E–6. 
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1 ‘‘(2) PERIOD OF PAYMENT.—In the case of an 

2 individual who participates in the program estab3 lished by this title, the monthly premium shall be 

4 payable for the period commencing with the first 

5 month of the individual’s coverage period and ending 

6 with the month in which the individual’s coverage 

7 under this title terminates. 

8 ‘‘(b) APPLICATION OF CERTAIN PROVISIONS.—The 

9 provisions of section 1840 (other than subsection (h)) 

10 shall apply to premiums collected under this section in the 

11 same manner as they apply to premiums collected under 

12 part B, except that any reference in such section to the 

13 Federal Supplementary Medical Insurance Trust Fund is 

14 deemed a reference to the Trust Fund established under 

15 section 1860E–6. 

16 ‘‘SEC. 1860E–5. PROVISIONS RELATING TO EMPLOYMENT17 BASED RETIREE HEALTH COVERAGE. 

18 ‘‘(a) IN GENERAL.—In the case of an individual who 

19 would be eligible to enroll under this part but for the pro20 vision of employment-based retiree health coverage by an 

21 employer to the individual, notwithstanding the limitation 

22 under section 1860E–1(b)(1)(C), the individual is eligible 

23 to enroll under this part. 

24 ‘‘(b) MAINTENANCE OF EFFORT.—In the case of an 

25 employer that offers employment-based retiree health cov-
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1 erage to an individual who enrolls under this part, upon 

2 enrollment of the individual under this part, the employer 

3 may modify such coverage to provide for the following ben4 efits: 

5 ‘‘(1) Payment is made by the employer under 

6 such coverage for items and services for which pay7 ment may not be made under this title. 

8 ‘‘(2) Payment is made by the employer spon9 soring such coverage of 25 percent of the monthly 

10 premium under section 1860E–3 applicable to the 

11 individual after enrollment under this part. 

12 ‘‘(c) EMPLOYMENT-BASED RETIREE HEALTH COV13 ERAGE.—The term ‘employment-based retiree health cov14 erage’ has the meaning given that term in section 1860D–

15 22(c)(1), except that, for purposes of this part, any ref16 erence in such section to ‘part D’ is deemed to be a ref17 erence to ‘part E’. 

18 ‘‘SEC. 1860E–6. MEDICARE EARLY ACCESS TRUST FUND. 

19 ‘‘(a) ESTABLISHMENT OF TRUST FUND.—

20 ‘‘(1) IN GENERAL.—There is hereby created on 

21 the books of the Treasury of the United States a 

22 trust fund to be known as the ‘Medicare Early Ac23 cess Trust Fund’ (in this section referred to as the 

24 ‘Trust Fund’). The Trust Fund shall consist of such 

25 gifts and bequests as may be made as provided in
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1 section 201(i)(1) and such amounts as may be de2 posited in, or appropriated to, such fund as provided 

3 in this title. 

4 ‘‘(2) PREMIUMS.—Premiums collected under 

5 section 1860E–3 and payable under section 1860E–

6 5(a)(2) shall be transferred to the Trust Fund. 

7 ‘‘(b) INCORPORATION OF PROVISIONS.—

8 ‘‘(1) IN GENERAL.—Subject to paragraph (2), 

9 subsections (b) through (i) of section 1841 shall 

10 apply with respect to the Trust Fund and this title 

11 in the same manner as they apply with respect to 

12 the Federal Supplementary Medical Insurance Trust 

13 Fund and part B, respectively. 

14 ‘‘(2) MISCELLANEOUS REFERENCES.—In apply15 ing provisions of section 1841 under paragraph 

16 (1)—

17 ‘‘(A) any reference in such section to ‘this 

18 part’ is construed to refer to this part E; 

19 ‘‘(B) any reference in section 1841(h) to 

20 section 1840(d) and in section 1841(i) to sec21 tions 1840(b)(1) and 1842(g) are deemed ref22 erences to comparable authority exercised under 

23 this part; and 

24 ‘‘(C) payments may be made under section 

25 1841(g) to the Trust Funds under sections 
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1 1817 and 1841 as reimbursement to such funds 

2 for payments they made for benefits provided 

3 under this part. 

4 ‘‘SEC. 1860E–7. OVERSIGHT AND ACCOUNTABILITY. 

5 ‘‘(a) THROUGH ANNUAL REPORTS OF TRUSTEES.—

6 The Board of Trustees of the Medicare Early Access 

7 Trust Fund under section 1860E–6(b)(1) shall report on 

8 an annual basis to Congress concerning the status of the 

9 Trust Fund and the need for adjustments in the program 

10 under this part to maintain financial solvency of the pro11 gram under this part. 

12 ‘‘(b) PERIODIC GAO REPORTS.—The Comptroller 

13 General of the United States shall periodically submit to 

14 Congress reports on the adequacy of the financing of cov15 erage provided under this part. The Comptroller General 

16 shall include in such report such recommendations for ad17 justments in such financing and coverage as the Comp18 troller General deems appropriate in order to maintain fi19 nancial solvency of the program under this part. 

20 ‘‘SEC. 1860E–8. ADMINISTRATION AND MISCELLANEOUS. 

21 ‘‘(a) TREATMENT FOR PURPOSES OF TITLE.—Ex22 cept as otherwise provided in this part—

23 ‘‘(1) individuals enrolled under this part shall 

24 be treated for purposes of this title as though the in-
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1 dividual were entitled to benefits and enrolled under 

2 any part of this title; and 

3 ‘‘(2) benefits described in section 1860E–1 

4 shall be payable under this title to such individuals 

5 in the same manner as if such individuals were so 

6 entitled and enrolled. 

7 ‘‘(b) NOT TREATED AS MEDICARE PROGRAM FOR

8 PURPOSES OF MEDICAID PROGRAM.—For purposes of ap9 plying title XIX (including the provision of medicare cost10 sharing assistance under such title), an individual who is 

11 enrolled under this part shall not be treated as being enti12 tled to benefits under this title. 

13 ‘‘(c) NOT TREATED AS MEDICARE PROGRAM FOR

14 PURPOSES OF COBRA CONTINUATION PROVISIONS.—In 

15 applying a COBRA continuation provision (as defined in 

16 section 2791(d)(4) of the Public Health Service Act), any 

17 reference to an entitlement to benefits under this title 

18 shall not be construed to include entitlement to benefits 

19 under this title pursuant to the operation of this part.’’. 

20 (b) CONFORMING AMENDMENTS TO SOCIAL SECU21 RITY ACT PROVISIONS.—(1) Section 201(i)(1) of the So22 cial Security Act (42 U.S.C. 401(i)(1)) is amended by 

23 striking ‘‘or the Federal Supplementary Medical Insur24 ance Trust Fund’’ and inserting ‘‘the Federal Supple-
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1 mentary Medical Insurance Trust Fund, and the Medicare 

2 Early Access Trust Fund’’. 

3 (2) Section 201(g)(1)(A) of such Act (42 U.S.C. 

4 401(g)(1)(A)) is amended by striking ‘‘and the Federal 

5 Supplementary Medical Insurance Trust Fund established 

6 by title XVIII’’ and inserting ‘‘, the Federal Supple7 mentary Medical Insurance Trust Fund, and the Medicare 

8 Early Access Trust Fund established by title XVIII’’. 

9 (3) Section 1820(i) of such Act (42 U.S.C. 1395i–

10 4(i)) is amended by striking ‘‘part D’’ and inserting ‘‘part 

11 F’’. 

12 (4) Section 1853 of such Act (42 U.S.C. 1395w–23), 

13 as amended by section 222(d) of the Medicare Prescrip14 tion Drug, Improvement, and Modernization Act of 2003 

15 (Public Law 108–173), is amended by adding at the end 

16 the following new subsection: 

17 ‘‘(k) ADJUSTMENT FOR EARLY ACCESS.—In apply18 ing this section with respect to individuals entitled to bene19 fits under part E, the Secretary shall provide for an appro20 priate adjustment in, for 2005, the Medicare+Choice capi21 tation rate, and for years beginning with 2006, the pay22 ment amount determined under this section or section 

23 1858, as may be appropriate to reflect differences between

24 the population served under such part and the population 

25 under parts A and B.’’. 
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1 (5) Section 1860D–15(c)(1) of such Act, as added 

2 by section 101(a) of the Medicare Prescription Drug, Im3 provement, and Modernization Act of 2003 (Public Law 

4 108–173), is amended by adding at the end the following 

5 new subparagraph: 

6 ‘‘(E) ADJUSTMENT FOR EARLY ACCESS.—

7 In applying this section with respect to individ8 uals entitled to benefits under part E, the Sec9 retary shall provide for an appropriate adjust10 ment in the payment amount determined under 

11 this section as may be appropriate to reflect dif12 ferences between the population served under 

13 such part and the population under parts A and 

14 B.’’. 

15 (c) OTHER CONFORMING AMENDMENTS.—(1) Sec16 tion 602(2)(D)(ii) of the Employee Retirement Income Se17 curity Act of 1974 (29 U.S.C. 1162(2)) is amended by 

18 inserting ‘‘(not including an individual who is so entitled 

19 pursuant to enrollment under section 1860E–1)’’ after 

20 ‘‘Social Security Act’’. 

21 (2) Section 2202(2)(D)(ii) of the Public Health Serv22 ice Act (42 U.S.C. 300bb–2(2)(D)(ii)) is amended by in23 serting ‘‘(not including an individual who is so entitled 

24 pursuant to enrollment under section 1860E–1)’’ after 

25 ‘‘Social Security Act’’. 
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1 (3) Section 4980B(f)(2)(B)(i)(V) of the Internal Rev2 enue Code of 1986 is amended by inserting ‘‘(not includ3 ing an individual who is so entitled pursuant to enrollment 

4 under section 1860E–1)’’ after ‘‘Social Security Act’’. 

5 TITLE II—REFUNDABLE AND 

6 ADVANCEABLE CREDIT 

7 AGAINST INCOME TAX FOR 

8 MEDICARE BUY-IN PREMIUMS 

9 SEC. 201. REFUNDABLE AND ADVANCEABLE INCOME TAX 

10 CREDIT FOR MEDICARE BUY-IN PREMIUMS. 

11 (a) IN GENERAL.—Subpart C of part IV of sub12 chapter A of chapter 1 of the Internal Revenue Code of 

13 1986 (relating to refundable personal credits) is amended 

14 by redesignating section 36 as section 37 and by inserting 

15 after section 35 the following new section: 

16 ‘‘SEC. 36. MEDICARE BUY-IN PREMIUMS. 

17 ‘‘(a) IN GENERAL.—In the case of an individual, 

18 there shall be allowed as a credit against the tax imposed 

19 by this chapter for the taxable year an amount equal to 

20 75 percent of the amount paid during such year as medi21 care buy-in coverage premiums. 

22 ‘‘(b) DEFINITIONS.—For purposes of this section the 

23 term ‘medicare buy-in coverage premiums’ means pre24 miums paid under part E of title XVIII of the Social Secu25 rity Act. 
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1 ‘‘(c) COORDINATION WITH ADVANCE PAYMENT.—

2 With respect to any taxable year, the amount which would 

3 (but for this subsection) be allowed as a credit under sub4 section (a) shall be reduced (but not below zero) by the 

5 aggregate amount paid on behalf of such taxpayer under 

6 section 7528 for such taxable year.’’. 

7 (b) ADVANCE PAYMENT OF CREDIT.—Chapter 77 of 

8 such Code (relating to miscellaneous provisions) is amend9 ed by adding at the end the following new section: 

10 ‘‘SEC. 7528. ADVANCE PAYMENT OF CREDIT FOR MEDICARE 

11 BUY-IN PREMIUMS. 

12 ‘‘(a) GENERAL RULE.—The Secretary shall establish 

13 a program for making payments on behalf of individuals 

14 enrolled under part E of title XVIII of the Social Security 

15 Act to the Secretary of Health and Human Services for 

16 premiums payable by such individuals under such part. 

17 ‘‘(b) LIMITATION ON ADVANCE PAYMENTS DURING

18 ANY TAXABLE YEAR.—The Secretary may make pay19 ments under subsection (a) only to the extent that the 

20 total amount of such payments made on behalf of any indi21 vidual during the taxable year does not exceed the amount 

22 allowable as a credit to such individual for such year under 

23 section 36 (determined without regard to subsection (c) 

24 thereof).’’. 

25 (c) CONFORMING AMENDMENTS.—
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1 (1) Paragraph (2) of section 1324(b) of title 

2 31, United States Code, is amended by inserting ‘‘or 

3 36’’ after ‘‘section 35’’. 

4 (2) The table of sections for subpart C of part 

5 IV of subchapter A of chapter 1 of the Internal Rev6 enue Code of 1986 is amended by striking the item 

7 relating to section 36 and inserting the following 

8 new items:

‘‘36. Medicare buy-in premiums. 

‘‘37. Overpayments of tax.’’.

9 (3) The table of sections for chapter 77 of such 

10 Code is amended by adding at the end the following 

11 new item:

‘‘7528. Advance payment of credit for medicare buy-in premiums.’’.

12 (d) EFFECTIVE DATE.—The amendments made by 

13 this section shall apply to taxable years beginning after 

14 December 31, 2004.

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