the cost of the test or treatment. Insured non-elderly 
adults are at least 50 percent more likely than unin-
sured adults to have preventive care such as pap 
smears, mammograms, and prostate exams. 
(11) According to a 2003 Kaiser Family Foun-
dation report, uninsured children also have problems 
getting needed health care. Uninsured children are 
much more likely than insured children to lack a 
usual source of health care, to delay health care, or 
to have unmet medical needs. Uninsured children 
with common childhood illnesses and injuries often 
do not receive the same level of care as insured chil-
dren. As a result, uninsured children are at a higher 
risk for preventable hospitalizations and for missed 
diagnoses of serious health conditions. 
(12) According to a 2005 Kaiser Family Foun-
dation report, because uninsured individuals are less 
likely than insured individuals to have regular out-
patient care, they are more likely to be hospitalized 
for avoidable health problems. When uninsured indi-
viduals are hospitalized, they are more likely than 
insured individuals to receive fewer services and to 
die in the hospital. 
(13) According to a 2006 Kaiser Family Foun-
dation report, having health insurance improves 
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health overall and access to health insurance by 
those who are currently uninsured could reduce the 
mortality rates for such uninsured individuals by 10 
to 15 percent. It has been estimated that the num-
ber of excess deaths among uninsured adults who 
are between the ages of 25 and 64 years of age is 
in the range of 18,000 per year. 
SEC. 3. ACCESS TO MEDICARE BENEFITS FOR CERTAIN IN-
DIVIDUALS 21 TO 65 YEARS OF AGE. 
(a) IN GENERAL.—Title XVIII of the Social Security 
Act 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 21 TO 65 YEARS OF AGE 
‘‘PROGRAM BENEFITS; ELIGIBILITY 
‘‘SEC. 1860E–1. (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 (including the ability to enroll in 
plans under parts C and D) as an individual entitled 
to benefits under part A and enrolled under part B, 
except that the Secretary shall provide for the addi-
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tion of benefits under this part for prenatal care and 
family planning services. 
‘‘(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.—A program under 
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). 
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‘‘(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. 
‘‘(D) QUALIFIED
COVERAGE.—The term 
‘qualified coverage’ means coverage that has 
been certified by an actuary (who is a member 
of the American Academy of Actuaries or a 
comparable group) as having coverage that is 
actuarially equivalent to or better than the ac-
tuarial value of the coverage provided under 
parts A and B. 
‘‘(b) ELIGIBILITY OF CERTAIN INDIVIDUALS AGE 21 
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 21 years of 
age (or, in the case of an individual residing in 
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a State which applies (as of the date of the en-
actment of this section and under clause (i) of 
section 1905(a)) an age lower than 21, such 
lower age), but has not attained 65 years of 
age. 
‘‘(B) NOT ELIGIBLE FOR QUALIFIED COV-
ERAGE UNDER GROUP HEALTH PLANS OR FED-
ERAL HEALTH INSURANCE PROGRAMS.—The in-
dividual is not eligible for benefits or coverage 
that constitutes qualified coverage under a Fed-
eral 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 continuation provi-
sion) as of the last day of the month involved. 
‘‘(C) FAMILY INCOME BETWEEN 200 AND 
500 PERCENT OF FEDERAL POVERTY LEVEL.— 
The income of the individual’s family is at least 
200 percent, but does not exceed 500 percent, 
of the poverty line for a family of the size in-
volved. 
‘‘(D) NOT
COVERED
FOR
PREVIOUS
MONTHS.—During the 6 preceding months the 
individual was not receiving benefits or coverage 
that constitutes qualified coverage under a Fed-
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eral health insurance program, under a group 
health plan, or under individual health insur-
ance coverage. 
‘‘(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 each of the following requirements are met: 
‘‘(A) NEW QUALIFIED COVERAGE UNDER 
GROUP HEALTH PLAN OR FEDERAL HEALTH IN-
SURANCE PROGRAM.—After the date of termi-
nation of coverage under such section, the indi-
vidual obtains qualified 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 qualified coverage described in 
subparagraph (A) without regard to whether 
the individual has exhausted any eligibility the 
individual may subsequently have for coverage 
under a Federal or State COBRA continuation 
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provision and the individual meets the require-
ment of paragraph (1)(D). 
‘‘ENROLLMENT PROCESS; COVERAGE 
‘‘SEC. 1860E–2. (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 regula-
tions, and only during an enrollment period prescribed by 
the Secretary consistent with the provisions of this section. 
Such regulations shall provide a process under which indi-
viduals eligible to enroll as of a month are permitted to 
pre-enroll during a prior month within an enrollment pe-
riod described in subsection (b). 
‘‘(b) ENROLLMENT PERIODS.— 
‘‘(1) INDIVIDUALS 21 TO 65 YEARS OF AGE.—In 
the case of individuals eligible to enroll under this 
part under section 1860E–1(b), the following enroll-
ment periods shall apply: 
‘‘(A) INITIAL
ENROLLMENT
PERIOD.—If 
the individual is eligible to enroll under such 
section as of January 2008, the enrollment pe-
riod shall begin on November 1, 2007, and shall 
end on February 28, 2008. Any such enroll-
ment before January 1, 2008, is conditioned 
upon compliance with the conditions of eligi-
bility for January 2008. 
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‘‘(B) SUBSEQUENT PERIODS.—If the indi-
vidual is eligible to enroll under such section as 
of a month after January 2008, 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 
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, 2008: 
‘‘(A) FOR ENROLLMENTS BEFORE MONTH 
OF ELIGIBILITY.—In the case of an individual 
who enrolls (including pre-enrolls) before the 
month in which the individual first satisfies eli-
gibility for enrollment under section 1860E–1, 
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the first day of such month in which the indi-
vidual first satisfies eligibility. 
‘‘(B) FOR
ENROLLMENTS
DURING
OR 
AFTER MONTH OF ELIGIBILITY.—In the case of 
an individual who enrolls during or after the 
month in which the individual first satisfies eli-
gibility for enrollment under such section, the 
first day of the following 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.— 
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‘‘(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) ELIGIBILITY
FOR
MEDICARE, 
GROUP
HEALTH
PLAN, OR
OTHER
FED-
ERAL
HEALTH
INSURANCE.—The indi-
vidual becomes entitled to benefits or en-
rolled under any other part of this title 
(other than by reason of this part) or for 
qualified coverage under a group health 
plan or under another Federal health in-
surance program. 
‘‘(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 
the month for which the notice is filed. 
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‘‘(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 HEALTH INSURANCE ELIGI-
BILITY.—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 be-
comes entitled to benefits or enrolled under a 
plan or program described in subparagraph 
(A)(iii). 
‘‘(3) NO EFFECT OF TERMINATION ON CONTIN-
UED MEDICARE BENEFITS WHEN TURNS 65.—Noth-
ing in this subsection shall be construed as affecting 
the continuation of benefits under this title (other 
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than under this part) in the case of an individual 
who attains 65 years of age or who otherwise subse-
quently qualifies for benefits under this title other 
than under this part. 
‘‘PREMIUMS 
‘‘SEC. 1860E–3. (a) AMOUNT OF MONTHLY PRE-
MIUMS.—The Secretary shall, during September of each 
year (beginning with 2007), determine a monthly premium 
for individuals 21 years of age or older, equal to 1⁄12 of 
the annual premium 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. 
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