I 
116TH CONGRESS 
1ST SESSION H. R. 4527 
To amend title XVIII of the Social Security Act to provide an option for 
first responders age 50 to 64 who are separated from service due to 
retirement or disability to buy into Medicare. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 26, 2019 
Mr. MALINOWSKI (for himself, Mr. ROUDA, Mr. CARBAJAL, and Mr. KIM) in-
troduced the following bill; which was referred to the Committee on Ways 
and Means, and in addition to the Committee on Energy and Commerce, 
for a period to be subsequently 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 to provide 
an option for first responders age 50 to 64 who are 
separated from service due to retirement or disability 
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 ‘‘Expanding Health 
Care Options for Early Retirees Act’’. 
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SEC. 2. MEDICARE BUY-IN OPTION FOR FIRST RESPOND-
ERS 50 TO 64 YEARS OF AGE WHO ARE SEPA-
RATED FROM SERVICE DUE TO RETIREMENT 
OR DISABILITY. 
(a) IN GENERAL.—Title XVIII of the Social Security 
Act (42 U.S.C. 1395c et seq.) is amended by adding at 
the end the following new section: 
‘‘MEDICARE BUY-IN OPTION FOR FIRST RESPONDERS 50 
TO 64 YEARS OF AGE WHO ARE SEPARATED FROM 
SERVICE DUE TO RETIREMENT OR DISABILITY 
‘‘SEC. 1899C. (a) OPTION.— 
‘‘(1) IN GENERAL.—Every individual who meets 
the requirements described in paragraph (3) shall be 
eligible to enroll under this section. 
‘‘(2) PART A, B, AND D BENEFITS.—An indi-
vidual enrolled under this section is entitled to the 
same benefits (and shall receive the same protec-
tions) under this title as an individual who is enti-
tled to benefits under part A and enrolled under 
parts B and D, including the ability to enroll in a 
Medicare Advantage plan that provides qualified pre-
scription drug coverage (an MA–PD plan). 
‘‘(3) REQUIREMENTS
FOR
ELIGIBILITY.—The 
requirements described in this paragraph are the fol-
lowing: 
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‘‘(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 
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‘‘(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-
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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 
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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 
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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 
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under this section for purposes of section 36B of 
such Code. 
‘‘(3) ELIGIBILITY
FOR
COST-SHARING
SUB-
SIDIES.—For purposes of applying section 1402 of 
the Patient Protection and Affordable Care Act (42 
U.S.C. 18071)— 
‘‘(A) coverage provided under this section 
shall be treated as coverage under a qualified 
health plan in the silver level of coverage in the 
individual market offered through an Exchange; 
and 
‘‘(B) the Secretary shall be treated as the 
issuer of such plan. 
‘‘(4) MEDICAID
MANAGED
CARE.—States are 
prohibited from buying their Medicaid beneficiaries 
ages 50 to 64 into Medicare under this section, and 
individuals otherwise eligible for enrollment under a 
State plan under title XIX are prohibited from cov-
erage under this title pursuant to enrollment under 
this section. The preceding sentence shall not apply 
to Medicaid beneficiaries whose Medicaid coverage or 
eligibility does not meet the definition of minimum 
essential coverage under a government-sponsored 
program under section 1.5000A–2 of title 26, Code 
of Federal Regulations (or any successor regulation). 
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‘‘(5) COORDINATION WITH MARKET REFORMS, 
ETC.—Notwithstanding Treasury Notice 2015–17, 
no provision of law shall prevent an employer from 
maintaining an arrangement under which the em-
ployer pays or reimburses any portion of the pre-
miums for coverage under this section for retired 
employees of the employer, or prevent such payment 
or reimbursement from being excluded from the 
gross income of the individual enrolled in such cov-
erage for purposes of the Internal Revenue Code of 
1986. 
‘‘(g) GUARANTEED ISSUE
OF MEDIGAP POLICIES 
UPON FIRST ENROLLMENT AND EACH SUBSEQUENT EN-
ROLLMENT.—In the case of an individual who enrolls 
under this section (including an individual who was pre-
viously enrolled under this section), paragraphs (2)(A), 
(2)(D), (3)(B)(ii), and (3)(B)(vi) of section 1882(s)— 
‘‘(1) shall be applied by substituting ‘50’ for 
‘65’; 
‘‘(2) if the individual was enrolled under this 
section and subsequently disenrolls, shall apply each 
time the individual subsequently reenrolls under this 
section as if the individual had attained 50 years of 
age on the date of such reenrollment (and as if the 
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individual had never previously enrolled in a Medi-
care supplemental policy); and 
‘‘(3) shall be applied as if this section had not 
been enacted (and as if the individual had never pre-
viously enrolled in a Medicare supplemental policy) 
when the individual attains 65 years of age. 
‘‘(h) OVERSIGHT.—There is established an advisory 
committee to be known as the ‘Medicare Buy In Oversight 
Board’ to monitor and oversee the implementation of this 
section, including the experience of the individuals enroll-
ing under this section. The Medicare Buy In Oversight 
Board shall have members that include representatives of 
insurers, actuaries, consumer advocacy organizations, and 
individuals representing the first responder community, 
and shall make periodic recommendations for the con-
tinual improvement of the implementation of this section 
as well as the relationship of enrollment under this section 
to other health care programs. 
‘‘(i) OUTREACH AND ENROLLMENT.— 
‘‘(1) IN GENERAL.—During the period that be-
gins on January 1, 2020, and ends on December 31, 
2022, the Secretary shall award grants to eligible 
entities for the following purposes: 
‘‘(A) OUTREACH AND ENROLLMENT.—To 
carry out outreach, public education activities, 
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and enrollment activities to raise awareness of 
the availability of, and encourage, enrollment 
under this section. 
‘‘(B) ASSISTING INDIVIDUALS’ TRANSITION 
UNDER THIS SECTION.—To provide assistance 
to individuals to enroll under this section. 
‘‘(C) RAISING
AWARENESS
OF
PREMIUM 
ASSISTANCE
AND
COST-SHARING
REDUC-
TIONS.—To distribute fair and impartial infor-
mation concerning enrollment under this section 
and the availability of premium assistance tax 
credits under section 36B of the Internal Rev-
enue Code of 1986 and cost-sharing reductions 
under section 1402 of the Patient Protection 
and Affordable Care Act, and to assist eligible 
individuals in applying for such tax credits and 
cost-sharing reductions. 
‘‘(2) ELIGIBLE ENTITIES.— 
‘‘(A) IN GENERAL.—In this subsection, the 
term ‘eligible entity’ means— 
‘‘(i) a State; 
‘‘(ii) a nonprofit community-based or-
ganization; or 
‘‘(iii) a nonprofit first responder orga-
nization. 
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‘‘(B) ENROLLMENT AGENTS.—Such term 
includes a licensed independent insurance agent 
or broker that has an arrangement with a 
State, nonprofit community-based organization, 
or nonprofit first responder organization to en-
roll eligible individuals under this section. 
‘‘(C) EXCLUSIONS.—Such term does not 
include an entity that— 
‘‘(i) is a health insurance issuer; or 
‘‘(ii) receives any consideration, either 
directly or indirectly, from any health in-
surance issuer in connection with the en-
rollment of any individuals under this sec-
tion. 
‘‘(3) PRIORITY.—In awarding grants under this 
subsection, the Secretary shall give priority to 
awarding grants to States or eligible entities in 
States that have geographic rating areas at risk of 
having no qualified health plans in the individual 
market. 
‘‘(4) FUNDING.—For purposes of carrying out 
this subsection, there is appropriated to the Sec-
retary, out of any moneys in the Treasury not other-
wise appropriated, such sums as are necessary for 
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calendar year 2020 and for each subsequent cal-
endar year. 
‘‘(j) NO EFFECT ON BENEFITS FOR INDIVIDUALS 
OTHERWISE ELIGIBLE OR ON TRUST FUNDS.—The Sec-
retary shall implement the provisions of this section in 
such a manner to ensure that such provisions— 
‘‘(1) have no effect on the benefits under this 
title for individuals who are entitled to, or enrolled 
for, such benefits other than through this section; 
and 
‘‘(2) have no negative impact on the Federal 
Hospital Insurance Trust Fund or the Federal Sup-
plementary Medical Insurance Trust Fund (includ-
ing the Medicare Prescription Drug Account within 
such Trust Fund). 
‘‘(k) CONSULTATION.—In promulgating regulations 
to implement this section, the Secretary shall consult with 
interested parties, including groups representing bene-
ficiaries, health care providers, employers, insurance com-
panies, and organizations representing first responders.’’. 
Æ 
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