I 
111TH CONGRESS 
2D SESSION 
H. R. 4789 
To amend title XVIII of the Social Security Act to provide for an option 
for any citizen or permanent resident of the United States to buy 
into Medicare. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 9, 2010 
Mr. GRAYSON (for himself, Mr. FILNER, Mr. POLIS of Colorado, Ms. PINGREE 
of Maine, Ms. SHEA-PORTER, Ms. SCHAKOWSKY, Mr. FRANK of Massa-
chusetts, Mr. KUCINICH, Ms. EDWARDS of Maryland, Ms. WATSON, and 
Ms. JACKSON LEE of Texas) introduced the following bill; which was re-
ferred to the Committee on Ways and Means 
A BILL 
To amend title XVIII of the Social Security Act to provide 
for an option for any citizen or permanent resident of 
the United States to buy into Medicare. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Public Option Act’’ 
or the ‘‘Medicare You Can Buy Into Act’’. 
SEC. 2. UNIVERSAL MEDICARE BUY-IN OPTION. 
(a) IN GENERAL.—Part A of title XVIII of the Social 
Security Act is amended— 
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(1) in section 1818(a), by striking ‘‘or 1818A’’ 
and inserting ‘‘, 1818A, or 1818B’’; and 
(2) by inserting after section 1818A the fol-
lowing new section: 
‘‘UNIVERSAL BUY-IN 
‘‘SEC. 1818B. 
‘‘(a) IN GENERAL.—(a) Every individual who— 
‘‘(1) is a resident of the United States; 
‘‘(2) is either (A) a citizen or national of the 
United States, or (B) an alien lawfully admitted for 
permanent residence; and 
‘‘(3) is not otherwise entitled to benefits under 
this part or eligible to enroll under this part; 
shall be eligible to enroll in the insurance program estab-
lished by this part. An individual may enroll under this 
section only in such manner and form as may be pre-
scribed in regulations, and only during an enrollment pe-
riod prescribed in or under this section. 
‘‘(b) ENROLLMENT; COVERAGE.—The Secretary shall 
establish enrollment periods and coverage under this sec-
tion consistent with the principles for establishment of en-
rollment periods and coverage for individuals under sec-
tion 1818, except that no entitlement to benefits under 
this part shall be effective before the first day of the first 
calendar year beginning after the date of the enactment 
of this Act. 
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‘‘(c) PREMIUMS.— 
‘‘(1) IN
GENERAL.—The provisions of sub-
sections (d)(1), (d)(2), and (d)(3) of section 1818 
insofar as they apply to premiums (including collec-
tion of premiums) shall apply to premiums and col-
lection of premiums under this section, except 
that— 
‘‘(A) paragraphs (4) and (5) of section 
1818 shall not be applicable; and 
‘‘(B) the estimate of the monthly actuarial 
rate under section 1818(d) shall be computed 
and applied under this paragraph based upon 
costs incurred for individuals within each age 
cohort specified in paragraph (2) rather than 
for all individuals age 65 and older. 
‘‘(2) AGE COHORTS.—The age cohorts specified 
in this paragraph are as follows: 
‘‘(A) Individuals under 19 years of age. 
‘‘(B) Individuals at least 19 years of age 
but not more than 25 years of age. 
‘‘(C) Individuals at least 26 years of age 
and not more than 35 years of age. 
‘‘(D) Individuals at least 36 years of age 
and not more than 45 years of age. 
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‘‘(E) Individuals at least 46 years of age 
and not more than 55 years of age. 
‘‘(F) Individuals at least 56 years of age 
and not more than 64 years of age. 
‘‘(d) TREATMENT.—An individual enrolled under this 
part pursuant to this section shall not be treated as en-
rolled under this part (or any other part of this title) for 
purposes of obtaining medical assistance for medicare 
cost-sharing or otherwise under title XIX.’’. 
Æ 
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