‘‘(A) The individual is a resident of the 
United States. 
‘‘(B) The individual is— 
‘‘(i) a citizen or national of the United 
States; or 
‘‘(ii) an alien lawfully admitted for 
permanent residence. 
‘‘(C) The individual is not otherwise enti-
tled to benefits under part A or eligible to en-
roll under part A or part B. 
‘‘(D) The individual has attained 50 years 
of age but has not attained 65 years of age. 
‘‘(E) The individual is a qualified first re-
sponder (as defined in paragraph (4)(B)). 
‘‘(4) DEFINITIONS.—In this section: 
‘‘(A) FIRST RESPONDER.—The term ‘first 
responder’ means— 
‘‘(i) a qualified law enforcement offi-
cer (as defined in section 926B(c) of title 
18, United States Code); 
‘‘(ii) an employee described in clause 
(i) of section 72(t)(10)(B) of the Internal 
Revenue Code of 1986 who provides fire-
fighting services or emergency medical 
services; or 
VerDate Sep 11 2014 
03:46 Jul 10, 2021
Jkt 019200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H4148.IH
H4148
kjohnson on DSK79L0C42PROD with BILLS
‘‘(iii) a Federal firefighter described 
in section 8331(21) or 8401(14) of title 5, 
United States Code. 
‘‘(B) QUALIFIED FIRST RESPONDER.—The 
term ‘qualified first responder’ means a first re-
sponder who is separated from service due to 
retirement or disability. 
‘‘(b) ENROLLMENT AND COVERAGE PERIODS.— 
‘‘(1) IN GENERAL.—The Secretary shall estab-
lish enrollment and coverage periods for individuals 
who enroll under this section. 
‘‘(2) COORDINATION.—Such periods shall be es-
tablished in coordination with the enrollment and 
coverage periods for plans offered under an Ex-
change established under title I of the Patient Pro-
tection and Affordable Care Act and plans under 
parts C and D. If the Secretary determines appro-
priate, the Secretary may expand such enrollment 
periods beyond the enrollment periods under such an 
Exchange or under parts C and D. 
‘‘(3) BEGINNING OF COVERAGE AND SPECIAL 
ENROLLMENT PERIODS.—The Secretary shall estab-
lish such periods so that coverage under this section 
shall first begin on January 1 of the first year be-
ginning at least one year after the date of the enact-
VerDate Sep 11 2014 
03:46 Jul 10, 2021
Jkt 019200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H4148.IH
H4148
kjohnson on DSK79L0C42PROD with BILLS
ment of this section and shall include special enroll-
ment periods, in accordance with section 155.420 of 
title 45 of the Code of Federal Regulations, that are 
applicable to qualified health plans offered through 
an Exchange. 
‘‘(c) PREMIUM.— 
‘‘(1) AMOUNT OF MONTHLY PREMIUMS.—The 
Secretary shall (beginning for the 1st year that be-
gins more than 1 year after the date of enactment 
of this section) determine a monthly premium for all 
individuals enrolled under this section. Such monthly 
premium shall be equal to 1⁄12 of the annual pre-
mium computed under paragraph (2)(B), which 
shall apply with respect to coverage provided under 
this section for any month in the succeeding year. 
‘‘(2) ANNUAL PREMIUM.— 
‘‘(A) COMBINED PER CAPITA AVERAGE FOR 
ALL MEDICARE BENEFITS.—The Secretary shall 
estimate the average, annual per capita amount 
for benefits and administrative expenses that 
will be payable under parts A, B, and D (in-
cluding, as applicable, under part C) in the year 
for all individuals enrolled under this section. 
‘‘(B) ANNUAL PREMIUM.—The annual pre-
mium under this subsection for months in a 
VerDate Sep 11 2014 
03:46 Jul 10, 2021
Jkt 019200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H4148.IH
H4148
kjohnson on DSK79L0C42PROD with BILLS
year is equal to the average, annual per capita 
amount estimated under subparagraph (A) for 
the year. 
‘‘(3) INCREASED PREMIUM FOR CERTAIN PART 
C AND D PLANS.—Nothing in this section shall pre-
clude an individual from choosing a Medicare Advan-
tage plan or a prescription drug plan which requires 
the individual to pay an additional amount (because 
of supplemental benefits or because it is a more ex-
pensive plan). In such case the individual would be 
responsible for the increased monthly premium. 
‘‘(d) PAYMENT OF PREMIUMS.— 
‘‘(1) IN GENERAL.—Premiums for enrollment 
under this section shall be paid to the Secretary at 
such times, and in such manner, as the Secretary 
determines appropriate. 
‘‘(2) DEPOSIT.—Amounts collected by the Sec-
retary under this section shall be deposited in the 
Federal Hospital Insurance Trust Fund and the 
Federal Supplementary Medical Insurance Trust 
Fund (including the Medicare Prescription Drug Ac-
count within such Trust Fund) in such proportion 
as the Secretary determines appropriate. 
‘‘(e) NOT ELIGIBLE FOR MEDICARE COST-SHARING 
ASSISTANCE.—An individual enrolled under this section 
VerDate Sep 11 2014 
03:46 Jul 10, 2021
Jkt 019200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H4148.IH
H4148
kjohnson on DSK79L0C42PROD with BILLS
shall not be treated as enrolled under any part of this title 
for purposes of obtaining medical assistance for Medicare 
cost-sharing or otherwise under title XIX. 
‘‘(f) TREATMENT IN RELATION TO THE AFFORDABLE 
CARE ACT.— 
‘‘(1) SATISFACTION
OF
INDIVIDUAL
MAN-
DATE.—For purposes of applying section 5000A of 
the Internal Revenue Code of 1986, the coverage 
provided under this section constitutes minimum es-
sential coverage under subsection (f)(1)(A)(i) of 
such section 5000A. 
‘‘(2) ELIGIBILITY FOR PREMIUM ASSISTANCE.— 
Coverage provided under this section— 
‘‘(A) shall be treated as coverage under a 
qualified health plan in the individual market 
enrolled in through the Exchange where the in-
dividual resides for all purposes of section 36B 
of the Internal Revenue Code of 1986 other 
than subsection (c)(2)(B) thereof; and 
‘‘(B) shall not be treated as eligibility for 
other minimum essential coverage for purposes 
of subsection (c)(2)(B) of such section 36B. 
The Secretary shall determine the applicable second 
lowest cost silver plan which shall apply to coverage 
VerDate Sep 11 2014 
03:46 Jul 10, 2021
Jkt 019200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H4148.IH
H4148
kjohnson on DSK79L0C42PROD with BILLS