I
107TH CONGRESS
2D SESSION
H. R. 4684
To amend title XVIII of the Social Security Act and the Employee Retirement
Income Security Act of 1974 to improve access to health insurance
and Medicare benefits for individuals ages 55 to 65 to be fully funded
through premiums and anti-fraud provisions, to amend title XIX of
the Social Security Act to provide financial assistance for those individ-
uals who are too poor to afford the premiums, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
MAY 8, 2002
Mr. PALLONE introduced the following bill; which was referred to the Com-
mittee on Ways and Means, and in addition to the Committees on Energy
and Commerce and Education and the Workforce, for a period to be sub-
sequently 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
improve access to health insurance and Medicare benefits
for individuals ages 55 to 65 to be fully funded through
premiums and anti-fraud provisions, to amend title XIX
of the Social Security Act to provide financial assistance
for those individuals who are too poor to afford the
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
‘‘Early Medicare Access and Affordability Act of 2002’’.
(b) TABLE OF CONTENTS.—
Sec. 1. Short title; table of contents.
TITLE I—ACCESS TO MEDICARE BENEFITS FOR INDIVIDUALS 62-
TO-65 YEARS OF AGE
Sec. 101. Access to Medicare benefits for individuals 62-to-65 years of age.
‘‘PART D—PURCHASE OF MEDICARE BENEFITS BY CERTAIN INDIVIDUALS
AGE 62-TO-65 YEARS OF AGE
‘‘Sec. 1859. Program benefits; eligibility.
‘‘Sec. 1859A. Enrollment process; coverage.
‘‘Sec. 1859B. Premiums.
‘‘Sec. 1859C. Payment of premiums.
‘‘Sec. 1859D. Medicare Early Access Trust Fund.
‘‘Sec. 1859E. Oversight and accountability.
‘‘Sec. 1859F. Administration and miscellaneous.
TITLE II—ACCESS TO MEDICARE BENEFITS FOR DISPLACED
WORKERS 55-TO-62 YEARS OF AGE
Sec. 201. Access to Medicare benefits for displaced workers 55-to-62 years of
age.
TITLE III—COBRA PROTECTION FOR EARLY RETIREES
Subtitle A—Amendments to the Employee Retirement Income Security Act of
1974
Sec. 301. COBRA continuation benefits for certain retired workers who lose re-
tiree health coverage.
Subtitle B—Amendments to the Public Health Service Act
Sec. 311. COBRA continuation benefits for certain retired workers who lose re-
tiree health coverage.
Subtitle C—Amendments to the Internal Revenue Code of 1986
Sec. 321. COBRA continuation benefits for certain retired workers who lose re-
tiree health coverage.
TITLE IV—FINANCING
Sec. 401. Reference to financing provisions.
TITLE V—PROVISION OF PREMIUM ASSISTANCE FOR LOW-IN-
COME INDIVIDUALS PURCHASING EARLY COVERAGE UNDER
THE MEDICARE PROGRAM
Sec. 501. Provision of premium assistance for low-income individuals purchasing
early coverage under the Medicare program.
TITLE I—ACCESS TO MEDICARE
BENEFITS FOR INDIVIDUALS
62-TO-65 YEARS OF AGE
SEC. 101. ACCESS TO MEDICARE BENEFITS FOR INDIVID-
UALS 62-TO-65 YEARS OF AGE.
(a) IN GENERAL.—Title XVIII of the Social Security
Act (42 U.S.C. 1395 et seq.) is amended—
(1) by redesignating section 1859 and part D
as section 1858 and part E, respectively; and
(2) by inserting after such section the following
new part:
‘‘PART D—PURCHASE OF MEDICARE BENEFITS BY
CERTAIN INDIVIDUALS AGE 62-TO-65 YEARS OF AGE
‘‘SEC. 1859. 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
under part A and enrolled under part B.
‘‘(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.—Part A or part B 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 62-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 62 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
1859A(d) (other than because of age), the individual
is not again eligible to enroll under this subsection
unless 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) and exhausts 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. 1859A. 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—
‘‘(1) individuals eligible to enroll as of a month
are permitted to pre-enroll during a prior month
within an enrollment period described in subsection
(b); and
‘‘(2) each individual seeking to enroll under sec-
tion 1859(b) is notified, before enrolling, of the de-
ferred monthly premium amount the individual will
be liable for under section 1859C(b) upon attaining
65 years of age as determined under section
1859B(c)(3).
‘‘(b) ENROLLMENT PERIODS.—
‘‘(1) INDIVIDUALS 62-TO-65 YEARS OF AGE.—In
the case of individuals eligible to enroll under this
part under section 1859(b)—
‘‘(A) INITIAL
ENROLLMENT
PERIOD.—If
the individual is eligible to enroll under such
section for July 2003, the enrollment period
shall begin on May 1, 2003, and shall end on
August 31, 2003. Any such enrollment before
July 1, 2003, is conditioned upon compliance
with the conditions of eligibility for July 2003.
‘‘(B) SUBSEQUENT PERIODS.—If the indi-
vidual is eligible to enroll under such section for
a month after July 2003, the enrollment period
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 condi-
tions 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
July 1, 2003:
‘‘(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 1859, 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
under part A or enrolled under part B
(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 under part A or enrolled for
benefits under part B (other than by reason of
this part).
‘‘SEC. 1859B. PREMIUMS.
‘‘(a) AMOUNT OF MONTHLY PREMIUMS.—
‘‘(1) BASE
MONTHLY
PREMIUMS.—The Sec-
retary shall, during September of each year (begin-
ning with 2002), determine the following premium
rates which shall apply with respect to coverage pro-
vided under this title for any month in the suc-
ceeding year:
‘‘(A) BASE MONTHLY PREMIUM FOR INDI-
VIDUALS 62 YEARS OF AGE OR OLDER.—A base
monthly premium for individuals 62 years of
age or older, equal to 1⁄12 of the base annual
premium rate computed under subsection (b)
for each premium area.
‘‘(2) DEFERRED MONTHLY PREMIUMS FOR IN-
DIVIDUALS 62 YEARS OF AGE OR OLDER.—The Sec-
retary shall, during September of each year (begin-
ning with 2002), determine under subsection (c) the
amount of deferred monthly premiums that shall
apply with respect to individuals who first obtain
coverage under this part under section 1859(b) in
the succeeding year.
‘‘(3) ESTABLISHMENT OF PREMIUM AREAS.—
For purposes of this part, the term ‘premium area’
means such an area as the Secretary shall specify to
carry out this part. The Secretary from time to time
may change the boundaries of such premium areas.
The Secretary shall seek to minimize the number of
such areas specified under this paragraph.