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. EMAN-
UEL, 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 Vir-
ginia, 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. WOOL-
SEY) 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 subse-
quently 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 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.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Medicare Early Access Act of 2004’’. 
(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 cov-
erage. 
‘‘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.
TITLE I—ACCESS TO MEDICARE 
BENEFITS FOR INDIVIDUALS 
55 TO 65 YEARS OF AGE 
SEC. 101. ACCESS TO MEDICARE BENEFITS FOR INDIVID-
UALS 55 TO 65 YEARS OF AGE. 
(a) IN GENERAL.—Title XVIII of the Social Security 
Act, as amended by section 101(a) of the Medicare Pre-
scription Drug, Improvement, and Modernization Act of 
2003 (Public Law 108–173), is amended—
(1) by redesignating part E as part F; and 
(2) by inserting after part D the following new 
part: 
‘‘PART E—PURCHASE OF MEDICARE BENEFITS 
BY CERTAIN INDIVIDUALS 55 TO 65 YEARS OF 
AGE 
‘‘SEC. 1860E–1. PROGRAM BENEFITS; ELIGIBILITY. 
‘‘(a) ENTITLEMENT TO MEDICARE BENEFITS FOR 
ENROLLED INDIVIDUALS.—
‘‘(1) IN
GENERAL.—An individual enrolled 
under this part is entitled to the same benefits 
under this title as an individual entitled to benefits 
or enrolled under any part of this title. 
‘‘(2) DEFINITIONS.—For purposes of this part: 
‘‘(A) FEDERAL OR STATE COBRA CONTINU-
ATION PROVISION.—The term ‘Federal or State
COBRA continuation provision’ has the mean-
ing given the term ‘COBRA continuation provi-
sion’ in section 2791(d)(4) of the Public Health 
Service Act and includes a comparable State 
program, as determined by the Secretary. 
‘‘(B) FEDERAL HEALTH INSURANCE PRO-
GRAM DEFINED.—The term ‘Federal health in-
surance program’ means any of the following: 
‘‘(i) MEDICARE.—Any part of this 
title (other than by reason of this part). 
‘‘(ii) MEDICAID.—A State plan under 
title XIX. 
‘‘(iii) FEHBP.—The Federal employ-
ees health benefit program under chapter 
89 of title 5, United States Code. 
‘‘(iv) 
TRICARE.—The 
TRICARE 
program (as defined in section 1072(7) of 
title 10, United States Code). 
‘‘(v) ACTIVE DUTY MILITARY.—Health 
benefits under title 10, United States 
Code, to an individual as a member of the 
uniformed services of the United States. 
‘‘(C) GROUP
HEALTH
PLAN.—The term 
‘group health plan’ has the meaning given such
term in section 2791(a)(1) of the Public Health 
Service Act. 
‘‘(b) ELIGIBILITY OF INDIVIDUALS AGE 55 TO 65 
YEARS OF AGE.—
‘‘(1) IN GENERAL.—Subject to paragraph (2), 
an individual who meets the following requirements 
with respect to a month is eligible to enroll under 
this part with respect to such month: 
‘‘(A) AGE.—As of the last day of the 
month, the individual has attained 55 years of 
age, but has not attained 65 years of age. 
‘‘(B) MEDICARE
ELIGIBILITY
(BUT
FOR 
AGE).—The individual would be eligible for ben-
efits under part A or part B for the month if 
the individual were 65 years of age. 
‘‘(C) 
NOT
ELIGIBLE
FOR
COVERAGE 
UNDER
GROUP
HEALTH
PLANS
OR
FEDERAL 
HEALTH
INSURANCE
PROGRAMS.—The indi-
vidual is not eligible for benefits or coverage 
under a Federal health insurance program (as 
defined in subsection (a)(2)(B)) or under a 
group health plan (other than such eligibility 
merely through a Federal or State COBRA con-
tinuation provision) as of the last day of the 
month involved.
‘‘(2) LIMITATION
ON
ELIGIBILITY
IF
TERMI-
NATED ENROLLMENT.—If an individual described in 
paragraph (1) enrolls under this part and coverage 
of the individual is terminated under section 1860E–
2(d) (other than because of age), the individual is 
not again eligible to enroll under this subsection un-
less the following requirements are met: 
‘‘(A) NEW
COVERAGE
UNDER
GROUP 
HEALTH
PLAN
OR
FEDERAL
HEALTH
INSUR-
ANCE PROGRAM.—After the date of termination 
of coverage under such section, the individual 
obtains coverage under a group health plan or 
under a Federal health insurance program. 
‘‘(B) SUBSEQUENT
LOSS
OF
NEW
COV-
ERAGE.—The individual subsequently loses eli-
gibility for the coverage described in subpara-
graph (A) without regard to whether the indi-
vidual has exhausted any eligibility the indi-
vidual may subsequently have for coverage 
under a Federal or State COBRA continuation 
provision. 
‘‘(3) CHANGE
IN
HEALTH
PLAN
ELIGIBILITY 
DOES NOT AFFECT COVERAGE.—In the case of an 
individual who is eligible for and enrolls under this 
part under this subsection, the individual’s continued
entitlement to benefits under this part shall not be 
affected by the individual’s subsequent eligibility for 
benefits or coverage described in paragraph (1)(C), 
or entitlement to such benefits or coverage. 
‘‘SEC. 1860E–2. ENROLLMENT PROCESS; COVERAGE. 
‘‘(a) IN GENERAL.—An individual may enroll in the 
program established under this part only in such manner 
and form as may be prescribed by regulations, and only 
during an enrollment period prescribed by the Secretary 
consistent with the provisions of this section. Such regula-
tions shall provide a process under which individuals eligi-
ble to enroll as of a month are permitted to pre-enroll dur-
ing a prior month within an enrollment period described 
in subsection (b). 
‘‘(b) ENROLLMENT PERIODS.—
‘‘(1) INDIVIDUALS 55 TO 65 YEARS OF AGE.—In 
the case of individuals eligible to enroll under this 
part under section 1860E–1(b)—
‘‘(A) INITIAL
ENROLLMENT
PERIOD.—If 
the individual is eligible to enroll under such 
section for January 2005, the enrollment period 
shall begin on November 1, 2004, and shall end 
on February 28, 2005. Any such enrollment be-
fore January 1, 2005, is conditioned upon com-
pliance with the conditions of eligibility for Jan-
uary 2005. 
‘‘(B) SUBSEQUENT PERIODS.—If the indi-
vidual is eligible to enroll under such section for 
a month after January 2005, the enrollment pe-
riod shall begin on the first day of the second 
month before the month in which the individual 
first is eligible to so enroll and shall end four 
months later. Any such enrollment before the 
first day of the third month of such enrollment 
period is conditioned upon compliance with the 
conditions of eligibility for such third month. 
‘‘(2) AUTHORITY
TO
CORRECT
FOR
GOVERN-
MENT ERRORS.—The provisions of section 1837(h) 
apply with respect to enrollment under this part in 
the same manner as they apply to enrollment under 
part B. 
‘‘(c) DATE COVERAGE BEGINS.—
‘‘(1) IN GENERAL.—The period during which 
an individual is entitled to benefits under this part 
shall begin as follows, but in no case earlier than 
January 1, 2005: 
‘‘(A) In the case of an individual who en-
rolls (including pre-enrolls) before the month in 
which the individual satisfies eligibility for en-
rollment under section 1860E–1, the first day 
of such month of eligibility. 
‘‘(B) In the case of an individual who en-
rolls during or after the month in which the in-
dividual first satisfies eligibility for enrollment 
under such section, the first day of the fol-
lowing month. 
‘‘(2) AUTHORITY
TO
PROVIDE
FOR
PARTIAL 
MONTHS
OF
COVERAGE.—Under regulations, the 
Secretary may, in the Secretary’s discretion, provide 
for coverage periods that include portions of a 
month in order to avoid lapses of coverage. 
‘‘(3) LIMITATION ON PAYMENTS.—No payments 
may be made under this title with respect to the ex-
penses of an individual enrolled under this part un-
less such expenses were incurred by such individual 
during a period which, with respect to the individual, 
is a coverage period under this section. 
‘‘(d) TERMINATION OF COVERAGE.—
‘‘(1) IN
GENERAL.—An individual’s coverage 
period under this part shall continue until the indi-
vidual’s enrollment has been terminated at the ear-
liest of the following: 
‘‘(A) GENERAL PROVISIONS.—
‘‘(i) NOTICE.—The individual files no-
tice (in a form and manner prescribed by 
the Secretary) that the individual no 
longer wishes to participate in the insur-
ance program under this part. 
‘‘(ii) NONPAYMENT OF PREMIUMS.—
The individual fails to make payment of 
premiums required for enrollment under 
this part. 
‘‘(iii) MEDICARE
ELIGIBILITY.—The 
individual becomes entitled to benefits or 
enrolled under any other part of this title 
(other than by reason of this part). 
‘‘(B) TERMINATION BASED ON AGE.—The 
individual attains 65 years of age. 
‘‘(2) EFFECTIVE DATE OF TERMINATION.—
‘‘(A) NOTICE.—The termination of a cov-
erage period under paragraph (1)(A)(i) shall 
take effect at the close of the month following 
for which the notice is filed. 
‘‘(B) NONPAYMENT
OF
PREMIUM.—The 
termination of a coverage period under para-
graph (1)(A)(ii) shall take effect on a date de-
termined under regulations, which may be de-
termined so as to provide a grace period in
which overdue premiums may be paid and cov-
erage continued. The grace period determined 
under the preceding sentence shall not exceed 
60 days; except that it may be extended for an 
additional 30 days in any case where the Sec-
retary determines that there was good cause for 
failure to pay the overdue premiums within 
such 60-day period. 
‘‘(C) AGE
OR
MEDICARE
ELIGIBILITY.—
The termination of a coverage period under 
paragraph (1)(A)(iii) or (1)(B) shall take effect 
as of the first day of the month in which the 
individual attains 65 years of age or becomes 
entitled to benefits or enrolled in any other part 
of this title (other than by reason of this part). 
‘‘SEC. 1860E–3. PREMIUMS. 
‘‘(a) AMOUNT OF MONTHLY PREMIUMS.—The Sec-
retary shall, during September of each year (beginning 
with 2004), determine a monthly premium for individuals 
55 years of age or older, equal to 1⁄12 of the annual pre-
mium computed under subsection (b)(2), which shall apply 
with respect to coverage provided under this title for any 
month in the succeeding year. 
‘‘(b) ANNUAL PREMIUM.—
‘‘(1) NATIONAL, PER
CAPITA
AVERAGE.—The 
Secretary shall estimate the average, annual per 
capita amount that would be payable under this title 
with respect to individuals residing in the United 
States who meet the requirement of section 1860E–
1(b)(1)(A) as if all such individuals were eligible for 
(and enrolled) under this title during the entire year 
(and assuming that section 1862(b)(2)(A)(i) did not 
apply). 
‘‘(2) ANNUAL PREMIUM.—The annual premium 
under this subsection for months in a year is equal 
to the average, annual per capita amount estimated 
under paragraph (1) for the year. 
‘‘SEC. 1860E–4. PAYMENT OF PREMIUMS. 
‘‘(a) PAYMENT OF MONTHLY PREMIUM.—
‘‘(1) IN GENERAL.—The Secretary shall provide 
for payment and collection of the monthly premium, 
determined under section 1860E–3(a) for the age of 
the individual involved, in the same manner as for 
payment of monthly premiums under section 1840, 
except that, for purposes of applying this section, 
any reference in such section to the Federal Supple-
mentary Medical Insurance Trust Fund is deemed a 
reference to the Trust Fund established under sec-
tion 1860E–6.
‘‘(2) PERIOD OF PAYMENT.—In the case of an 
individual who participates in the program estab-
lished by this title, the monthly premium shall be 
payable for the period commencing with the first 
month of the individual’s coverage period and ending 
with the month in which the individual’s coverage 
under this title terminates. 
‘‘(b) APPLICATION OF CERTAIN PROVISIONS.—The 
provisions of section 1840 (other than subsection (h)) 
shall apply to premiums collected under this section in the 
same manner as they apply to premiums collected under 
part B, except that any reference in such section to the 
Federal Supplementary Medical Insurance Trust Fund is 
deemed a reference to the Trust Fund established under 
section 1860E–6. 
‘‘SEC. 1860E–5. PROVISIONS RELATING TO EMPLOYMENT-
BASED RETIREE HEALTH COVERAGE. 
‘‘(a) IN GENERAL.—In the case of an individual who 
would be eligible to enroll under this part but for the pro-
vision of employment-based retiree health coverage by an 
employer to the individual, notwithstanding the limitation 
under section 1860E–1(b)(1)(C), the individual is eligible 
to enroll under this part. 
‘‘(b) MAINTENANCE OF EFFORT.—In the case of an 
employer that offers employment-based retiree health cov-
erage to an individual who enrolls under this part, upon 
enrollment of the individual under this part, the employer 
may modify such coverage to provide for the following ben-
efits: 
‘‘(1) Payment is made by the employer under 
such coverage for items and services for which pay-
ment may not be made under this title. 
‘‘(2) Payment is made by the employer spon-
soring such coverage of 25 percent of the monthly 
premium under section 1860E–3 applicable to the 
individual after enrollment under this part. 
‘‘(c) EMPLOYMENT-BASED RETIREE HEALTH COV-
ERAGE.—The term ‘employment-based retiree health cov-
erage’ has the meaning given that term in section 1860D–
22(c)(1), except that, for purposes of this part, any ref-
erence in such section to ‘part D’ is deemed to be a ref-
erence to ‘part E’. 
‘‘SEC. 1860E–6. MEDICARE EARLY ACCESS TRUST FUND. 
‘‘(a) ESTABLISHMENT OF TRUST FUND.—
‘‘(1) IN GENERAL.—There is hereby created on 
the books of the Treasury of the United States a 
trust fund to be known as the ‘Medicare Early Ac-
cess Trust Fund’ (in this section referred to as the 
‘Trust Fund’). The Trust Fund shall consist of such 
gifts and bequests as may be made as provided in
section 201(i)(1) and such amounts as may be de-
posited in, or appropriated to, such fund as provided 
in this title. 
‘‘(2) PREMIUMS.—Premiums collected under 
section 1860E–3 and payable under section 1860E–
5(a)(2) shall be transferred to the Trust Fund. 
‘‘(b) INCORPORATION OF PROVISIONS.—
‘‘(1) IN GENERAL.—Subject to paragraph (2), 
subsections (b) through (i) of section 1841 shall 
apply with respect to the Trust Fund and this title 
in the same manner as they apply with respect to 
the Federal Supplementary Medical Insurance Trust 
Fund and part B, respectively. 
‘‘(2) MISCELLANEOUS REFERENCES.—In apply-
ing provisions of section 1841 under paragraph 
(1)—
‘‘(A) any reference in such section to ‘this 
part’ is construed to refer to this part E; 
‘‘(B) any reference in section 1841(h) to 
section 1840(d) and in section 1841(i) to sec-
tions 1840(b)(1) and 1842(g) are deemed ref-
erences to comparable authority exercised under 
this part; and 
‘‘(C) payments may be made under section 
1841(g) to the Trust Funds under sections
1817 and 1841 as reimbursement to such funds 
for payments they made for benefits provided 
under this part. 
‘‘SEC. 1860E–7. OVERSIGHT AND ACCOUNTABILITY. 
‘‘(a) THROUGH ANNUAL REPORTS OF TRUSTEES.—
The Board of Trustees of the Medicare Early Access 
Trust Fund under section 1860E–6(b)(1) shall report on 
an annual basis to Congress concerning the status of the 
Trust Fund and the need for adjustments in the program 
under this part to maintain financial solvency of the pro-
gram under this part. 
‘‘(b) PERIODIC GAO REPORTS.—The Comptroller 
General of the United States shall periodically submit to 
Congress reports on the adequacy of the financing of cov-
erage provided under this part. The Comptroller General 
shall include in such report such recommendations for ad-
justments in such financing and coverage as the Comp-
troller General deems appropriate in order to maintain fi-
nancial solvency of the program under this part. 
‘‘SEC. 1860E–8. ADMINISTRATION AND MISCELLANEOUS. 
‘‘(a) TREATMENT FOR PURPOSES OF TITLE.—Ex-
cept as otherwise provided in this part—
‘‘(1) individuals enrolled under this part shall 
be treated for purposes of this title as though the in-
dividual were entitled to benefits and enrolled under 
any part of this title; and 
‘‘(2) benefits described in section 1860E–1 
shall be payable under this title to such individuals 
in the same manner as if such individuals were so 
entitled and enrolled. 
‘‘(b) NOT TREATED AS MEDICARE PROGRAM FOR 
PURPOSES OF MEDICAID PROGRAM.—For purposes of ap-
plying title XIX (including the provision of medicare cost-
sharing assistance under such title), an individual who is 
enrolled under this part shall not be treated as being enti-
tled to benefits under this title. 
‘‘(c) NOT TREATED AS MEDICARE PROGRAM FOR 
PURPOSES OF COBRA CONTINUATION PROVISIONS.—In 
applying a COBRA continuation provision (as defined in 
section 2791(d)(4) of the Public Health Service Act), any 
reference to an entitlement to benefits under this title 
shall not be construed to include entitlement to benefits 
under this title pursuant to the operation of this part.’’. 
(b) CONFORMING AMENDMENTS TO SOCIAL SECU-
RITY ACT PROVISIONS.—(1) Section 201(i)(1) of the So-
cial Security Act (42 U.S.C. 401(i)(1)) is amended by 
striking ‘‘or the Federal Supplementary Medical Insur-
ance Trust Fund’’ and inserting ‘‘the Federal Supple-
mentary Medical Insurance Trust Fund, and the Medicare 
Early Access Trust Fund’’. 
(2) Section 201(g)(1)(A) of such Act (42 U.S.C. 
401(g)(1)(A)) is amended by striking ‘‘and the Federal 
Supplementary Medical Insurance Trust Fund established 
by title XVIII’’ and inserting ‘‘, the Federal Supple-
mentary Medical Insurance Trust Fund, and the Medicare 
Early Access Trust Fund established by title XVIII’’. 
(3) Section 1820(i) of such Act (42 U.S.C. 1395i–
4(i)) is amended by striking ‘‘part D’’ and inserting ‘‘part 
F’’. 
(4) Section 1853 of such Act (42 U.S.C. 1395w–23), 
as amended by section 222(d) of the Medicare Prescrip-
tion Drug, Improvement, and Modernization Act of 2003 
(Public Law 108–173), is amended by adding at the end 
the following new subsection: 
‘‘(k) ADJUSTMENT FOR EARLY ACCESS.—In apply-
ing this section with respect to individuals entitled to bene-
fits under part E, the Secretary shall provide for an appro-
priate adjustment in, for 2005, the Medicare+Choice capi-
tation rate, and for years beginning with 2006, the pay-
ment amount determined under this section or section 
1858, as may be appropriate to reflect differences between
the population served under such part and the population 
under parts A and B.’’.
(5) Section 1860D–15(c)(1) of such Act, as added 
by section 101(a) of the Medicare Prescription Drug, Im-
provement, and Modernization Act of 2003 (Public Law 
108–173), is amended by adding at the end the following 
new subparagraph: 
‘‘(E) ADJUSTMENT FOR EARLY ACCESS.—
In applying this section with respect to individ-
uals entitled to benefits under part E, the Sec-
retary shall provide for an appropriate adjust-
ment in the payment amount determined under 
this section as may be appropriate to reflect dif-
ferences between the population served under 
such part and the population under parts A and 
B.’’. 
(c) OTHER CONFORMING AMENDMENTS.—(1) Sec-
tion 602(2)(D)(ii) of the Employee Retirement Income Se-
curity Act of 1974 (29 U.S.C. 1162(2)) is amended by 
inserting ‘‘(not including an individual who is so entitled 
pursuant to enrollment under section 1860E–1)’’ after 
‘‘Social Security Act’’. 
(2) Section 2202(2)(D)(ii) of the Public Health Serv-
ice Act (42 U.S.C. 300bb–2(2)(D)(ii)) is amended by in-
serting ‘‘(not including an individual who is so entitled 
pursuant to enrollment under section 1860E–1)’’ after 
‘‘Social Security Act’’.
(3) Section 4980B(f)(2)(B)(i)(V) of the Internal Rev-
enue Code of 1986 is amended by inserting ‘‘(not includ-
ing an individual who is so entitled pursuant to enrollment 
under section 1860E–1)’’ after ‘‘Social Security Act’’. 
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. 
(a) IN GENERAL.—Subpart C of part IV of sub-
chapter A of chapter 1 of the Internal Revenue Code of 
1986 (relating to refundable personal credits) is amended 
by redesignating section 36 as section 37 and by inserting 
after section 35 the following new section: 
‘‘SEC. 36. MEDICARE BUY-IN PREMIUMS. 
‘‘(a) IN GENERAL.—In the case of an individual, 
there shall be allowed as a credit against the tax imposed 
by this chapter for the taxable year an amount equal to 
75 percent of the amount paid during such year as medi-
care buy-in coverage premiums. 
‘‘(b) DEFINITIONS.—For purposes of this section the 
term ‘medicare buy-in coverage premiums’ means pre-
miums paid under part E of title XVIII of the Social Secu-
rity Act.
‘‘(c) COORDINATION WITH ADVANCE PAYMENT.—
With respect to any taxable year, the amount which would 
(but for this subsection) be allowed as a credit under sub-
section (a) shall be reduced (but not below zero) by the 
aggregate amount paid on behalf of such taxpayer under 
section 7528 for such taxable year.’’. 
(b) ADVANCE PAYMENT OF CREDIT.—Chapter 77 of 
such Code (relating to miscellaneous provisions) is amend-
ed by adding at the end the following new section: 
‘‘SEC. 7528. ADVANCE PAYMENT OF CREDIT FOR MEDICARE 
BUY-IN PREMIUMS. 
‘‘(a) GENERAL RULE.—The Secretary shall establish 
a program for making payments on behalf of individuals 
enrolled under part E of title XVIII of the Social Security 
Act to the Secretary of Health and Human Services for 
premiums payable by such individuals under such part. 
‘‘(b) LIMITATION ON ADVANCE PAYMENTS DURING 
ANY TAXABLE YEAR.—The Secretary may make pay-
ments under subsection (a) only to the extent that the 
total amount of such payments made on behalf of any indi-
vidual during the taxable year does not exceed the amount 
allowable as a credit to such individual for such year under 
section 36 (determined without regard to subsection (c) 
thereof).’’. 
(c) CONFORMING AMENDMENTS.—
(1) Paragraph (2) of section 1324(b) of title 
31, United States Code, is amended by inserting ‘‘or 
36’’ after ‘‘section 35’’. 
(2) The table of sections for subpart C of part 
IV of subchapter A of chapter 1 of the Internal Rev-
enue Code of 1986 is amended by striking the item 
relating to section 36 and inserting the following 
new items:
‘‘36. Medicare buy-in premiums. 
‘‘37. Overpayments of tax.’’.
(3) The table of sections for chapter 77 of such 
Code is amended by adding at the end the following 
new item:
‘‘7528. Advance payment of credit for medicare buy-in premiums.’’.
(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply to taxable years beginning after 
December 31, 2004.
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