‘‘(A) IN
GENERAL.—The Secretary shall 
provide for issuance of an appropriate card for 
individuals entitled to benefits under the pro-
gram under this title. 
‘‘(B) LINKING CARD TO AN ELECTRONIC 
HEALTH RECORD.— 
‘‘(i) IN GENERAL.—Not later than the 
sixth year the program under this title is 
in operation, the Secretary shall ensure 
that each such card is linked securely to an 
electronic health record for each such indi-
vidual. 
‘‘(ii) 
PRIVACY
PROTECTIONS.—The 
Secretary shall ensure that such card and 
such electronic health record include strong 
privacy protections. 
‘‘(iii) AUTHORITY.—In order to ac-
complish the linkage under clause (i), the 
Secretary is authorized to award grants, 
issue contracts, alter reimbursement under 
the program under this title, or provide 
such other incentives as are reasonable and 
necessary. 
‘‘(c) COVERAGE.— 
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‘‘(1) IN GENERAL.—Subject to paragraph (2), 
the Secretary shall provide for coverage of benefits 
for items and services furnished on and after the 
date an individual is entitled to benefits under the 
program under this title. 
‘‘(2) INITIAL COVERAGE.—No coverage is avail-
able under the program under this title for items 
and services furnished before the date that is 18 
months after the date of the enactment of the Medi-
care For All Act. 
‘‘(3) EXPIRATION OF COVERAGE.—An individ-
ual’s coverage under the program under this title 
shall terminate as of the date the individual is no 
longer an eligible individual. 
‘‘(d) RELATION TO OTHER PROGRAMS.— 
‘‘(1) CONSTRUCTION.— 
‘‘(A) CONTINUED OPERATION OF PUBLIC 
PROGRAMS.—Nothing in this title, including the 
application of subsection (b), shall be construed 
as requiring (or preventing) an individual who 
is entitled to benefits under the program under 
this title from obtaining benefits that best suit 
their needs under any other public health care 
program to which the individual is entitled, in-
cluding under a State Medicaid plan under title 
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XIX, the State Children’s Health Insurance 
Program under title XXI, a health program of 
the Department of Defense under chapter 55 of 
title 10, United States Code, a health program 
of the Department of Veterans Affairs under 
chapter 17 of title 38 of such Code, or a med-
ical care program of the Indian Health Service 
or of a tribal organization. 
‘‘(B) CONTINUED OPERATION OF PRIVATE 
HEALTH
INSURANCE.—Nothing in this title 
shall be construed as preventing— 
‘‘(i) an individual who is entitled to 
benefits under the program under this title 
from obtaining benefits that supplement or 
improve the benefits available under such 
program from any private health insurance 
plan or policy; or 
‘‘(ii) one or more employers from pro-
viding or funding, pursuant to a collective 
bargaining agreement, such supplemental 
or improved benefits for individuals who 
are entitled to benefits under the program 
under this title. 
‘‘(2) PRIMARY
PAYOR; OTHER
PUBLIC
PRO-
GRAMS PROVIDING WRAP AROUND BENEFITS.—The 
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program under this title shall be primary payor to 
other public health care benefit programs and the 
benefits under such other public health care benefit 
programs shall supplement the benefits under the 
program under this title. 
‘‘SEC. 2203. BENEFITS. 
‘‘(a) COMPREHENSIVE
BENEFIT
PACKAGE.—The 
Secretary shall provide for benefits under the program 
under this title consistent with the following: 
‘‘(1) MEDICARE FEE-FOR-SERVICE BENEFITS.— 
The benefits include the full range and scope of ben-
efits available under the original fee-for-service pro-
gram under parts A and B of title XVIII. 
‘‘(2) PRESCRIPTION
DRUG
COVERAGE.—The 
benefits include coverage of prescription drugs at 
least as comprehensive as the prescription drug cov-
erage offered as of January 1, 2007, under the Blue 
Cross/Blue Shield Standard Plan provided under the 
Federal employees health benefits program under 
chapter 89 of title 5, United States Code (in this 
title referred to as ‘FEHBP’). Such coverage shall 
be administered in the same manner as other bene-
fits under this section. 
‘‘(3) INCLUSION OF EPSDT SERVICES.—The 
benefits include early and periodic screening, diag-
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nostic, and treatment services described in sub-
sections (a)(4)(B) and (r) of section 1905 and pro-
vided in accordance with section 1903(a)(43). 
‘‘(4) PARITY IN COVERAGE OF MENTAL HEALTH 
BENEFITS.—There shall not be any treatment limi-
tations or financial requirements with respect to the 
coverage of benefits for mental illnesses unless com-
parable treatment limitations or financial require-
ments are imposed on medical and surgical benefits. 
Nothing in this paragraph shall be construed to re-
quire coverage for mental health benefits that are 
not medically necessary or to prohibit the appro-
priate medical management of such benefits. 
‘‘(5) PREVENTIVE
SERVICES.—The benefits 
shall include coverage of such additional preventive 
health care items and services as the Secretary shall 
specify, in consultation with the United States Pre-
ventive Services Task Force. 
‘‘(6) HOME
AND
COMMUNITY
BASED
SERV-
ICES.—The benefits shall include coverage of home 
and community-based services described in section 
1915(c)(4)(B). 
‘‘(7) ADDITIONAL
BENEFITS.—The benefits 
shall include such additional benefits that the Sec-
retary determines appropriate. 
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‘‘(8) REVISION.—Nothing in this subsection 
shall be construed as preventing the Secretary from 
improving the benefit package from time to time to 
account for changes in medical practice, new infor-
mation from medical research, and other relevant 
developments in health science. 
‘‘(9) ADJUSTMENT
AUTHORIZED.—The Sec-
retary shall, on a regular basis, evaluate whether 
adding any of the benefits described in paragraphs 
(1) through (7) is necessary or advisable to promote 
the health of beneficiaries under the program under 
title XVIII. The Secretary is authorized to improve 
the benefits available under such program, based 
upon such evaluation. 
‘‘(b) COST-SHARING.— 
‘‘(1) IN GENERAL.—Except as otherwise pro-
vided under this subsection or subsection (a)(4), 
with respect to the benefits described in subsection 
(a)(1), such benefits shall be subject to the cost- 
sharing (in the form of deductibles, coinsurance, and 
copayments) and premiums applicable under the 
program described in such subsection. 
‘‘(2) PRESCRIPTION
DRUG
COVERAGE.—With 
respect to the benefits described in subsection (a)(2), 
such benefits shall be subject to the cost-sharing (in 
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the form of deductibles, coinsurance, and copay-
ments) applicable under the plan described in such 
subsection. 
‘‘(3) TREATMENT OF PREVENTIVE AND ADDI-
TIONAL
SERVICES.—With respect to benefits de-
scribed in paragraphs (5) and (7) of subsection (a), 
such benefits shall be subject to cost-sharing (in the 
form of deductibles, coinsurance, and copayments) 
that is consistent (as determined by the Secretary) 
with the cost-sharing applicable under paragraph 
(1). 
‘‘(4) TREATMENT OF EPSDT AND HOME AND 
COMMUNITY-BASED SERVICES.—With respect to ben-
efits described in paragraphs (3) and (6) of sub-
section (a), such benefits shall be subject to nominal 
cost-sharing (in the form of deductibles, coinsurance, 
and copayments) that is consistent (as determined 
by the Secretary) with the cost-sharing applicable to 
such services under section 1916 (as in effect on 
January 1, 2007). 
‘‘(5) REDUCTION IN COST-SHARING FOR LOW- 
INCOME INDIVIDUALS.—The Secretary shall provide 
for reduced cost-sharing for low-income individuals 
in a manner that is no less protective than the re-
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duced cost-sharing for individuals under section 
1902(a)(10)(E) (as in effect on January 1, 2007). 
‘‘(6) FAMILY
PREMIUM.—The Secretary shall 
establish a premium for members of the same family 
with respect to benefits under the program under 
this title. 
‘‘(c) FREEDOM TO CHOOSE YOUR OWN DOCTOR AND 
HEALTH PLAN.—Except in the case of individuals who 
elect enrollment in a private health plan under section 
2204, the provisions of section 1802 shall apply under this 
title. 
‘‘(d) PAYMENT SCHEDULE.— 
‘‘(1) IN GENERAL.—The Secretary, with the as-
sistance of the Medicare Payment Advisory Commis-
sion, shall develop and implement a payment sched-
ule for benefits covered under the program under 
this title which are provided other than through pri-
vate health plans. To the extent feasible, such pay-
ment schedule shall be consistent with comparable 
payment schedules and reimbursement methodolo-
gies applied to benefits provided under parts A and 
B of title XVIII, except, that with respect to the 
coverage of prescription drugs, the Secretary shall 
provide for payment in accordance with a payment 
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schedule developed and implemented under the pre-
vious sentence. 
‘‘(2) ADDITIONAL PAYMENTS FOR QUALITY.— 
The Secretary shall establish procedures to provide 
reimbursement in addition to the reimbursement 
under paragraph (1) to health care providers that 
achieve measures (as established by the Secretary in 
consultation with health care professionals and 
groups representing eligible individuals) of health 
care quality. The Secretary shall ensure that such 
measures include measures of appropriate use of 
health information technology. 
‘‘(e) 
APPLICATION
OF
BENEFICIARY
PROTEC-
TIONS.—The Secretary shall provide for protections of 
beneficiaries under the program under this title that are 
not less than the beneficiary protections provided under 
title XVIII, including appeal rights and limitations on bal-
ance billing. 
‘‘SEC. 
2204. 
CHOICE 
OF 
COVERAGE 
UNDER 
PRIVATE 
HEALTH CARE DELIVERY SYSTEMS. 
‘‘(a) IN GENERAL.—The Secretary shall provide a 
process for— 
‘‘(1) the offering of private health plans for the 
provision of benefits under the program under this 
title; and 
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‘‘(2) the enrollment, disenrollment, termination, 
and change in enrollment of eligible individuals in 
such plans. 
‘‘(b) OFFERING OF PRIVATE HEALTH PLANS.— 
‘‘(1) IN GENERAL.—The Secretary shall enter 
into contracts with qualified entities for the offering 
of private health plans under the program under this 
title. In entering into such contracts the Secretary 
shall have the same authority that the Director of 
the Office of Personnel Management has with re-
spect to health benefits plans under FEHBP. 
‘‘(2) REQUIREMENTS.—The Secretary shall not 
enter into such a contract for the offering of a pri-
vate health plan under the program under this title 
unless at least the following requirements are met: 
‘‘(A) BENEFITS AS GOOD AS YOUR CON-
GRESSMAN GETS.—Benefits under such plans 
are similar to or no less than the health bene-
fits coverage in any of the 4 largest health ben-
efits plans (determined by enrollment) offered 
under FEHBP. Such plans may provide health 
benefits in addition to such required benefits 
and may impose a premium for the provision of 
benefits. Such plans may not provide for finan-
cial payments or rebates to enrollees. 
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‘‘(B) BENEFICIARY
PROTECTIONS.—En-
rollees in such plans have beneficiary protec-
tions that are not less than the beneficiary pro-
tections applicable under this title to individuals 
not so enrolled and shall include beneficiary 
protections applicable under both FEHBP and 
part C of title XVIII. 
‘‘(C) OTHER
ADMINISTRATIVE
REQUIRE-
MENTS.—The plans are subject to such require-
ments relating to licensure and solvency, protec-
tion against fraud and abuse, inspection, disclo-
sure, periodic auditing, and administrative oper-
ations and efficiencies as the Secretary identi-
fies, taking into account similar requirements 
under FEHBP and part C of title XVIII. 
‘‘(c) ANNUAL OPEN ENROLLMENT.—The process 
under subsection (a)(2) shall provide for an annual open 
enrollment period in which individuals may enroll, and 
change or terminate enrollment, in private health plans 
in a manner similar to that provided under FEHBP as 
of January 1, 2007. 
‘‘(d) PAYMENT TO PRIVATE HEALTH PLANS.— 
‘‘(1) IN GENERAL.—In the case of an individual 
enrolled in a private health plan under this section 
for a month, the Secretary shall provide for payment 
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of an amount equal to 1⁄12 of the annual per capita 
amount (described in paragraph (2), as adjusted 
under paragraph (3)). 
‘‘(2) ANNUAL PER CAPITA AMOUNT.—The an-
nual per capita amount under this paragraph shall 
be the annual average per capita cost of providing 
benefits under the program under this title (includ-
ing both individuals enrolled and not enrolled under 
private health plan), as computed by the Secretary 
based on rules similar to the rules described in sec-
tion 1876(a)(4). 
‘‘(3) RISK-ADJUSTMENT.—In making payment 
under this subsection, the Secretary shall apply risk 
adjustment factors similar to those applied to pay-
ments to Medicare Advantage organizations under 
section 1853, except that the Secretary shall ensure 
that payments under this subsection are adjusted 
based on such factors to ensure that the health sta-
tus of the enrollee is reflected in such adjusted pay-
ments, including adjusting for the difference between 
the health status of the enrollee and individuals re-
ceiving benefits under the program under this title 
who are not so enrolled. Payments under this sub-
section must, in aggregate, reflect such differences. 
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‘‘(e) REQUIREMENTS
FOR FEHBP CARRIERS.— 
Each contract entered into or renewed under section 8902 
of title 5, United States Code, shall require the carrier 
to offer a separate plan under this section on similar terms 
and conditions to, but with a separate risk pool from, the 
plan offered by the carrier under FEHBP. 
‘‘SEC. 2205. MEDICARE FOR ALL TRUST FUND. 
‘‘(a) ESTABLISHMENT OF TRUST FUND.—There is 
hereby created on the books of the Treasury of the United 
States a trust fund to be known as the ‘Medicare for All 
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 deposited in, or appropriated 
to, such fund as provided in this part. 
‘‘(b) TRANSFERS TO TRUST FUND.—There are here-
by appropriated to the Medicare for All Trust Fund, out 
of any moneys in the Treasury not otherwise appropriated, 
amounts equivalent to— 
‘‘(1) the taxes received in the Treasury under 
sections 1401(c), 3101(c), and 3111(c) of the Inter-
nal Revenue Code of 1986; 
‘‘(2) such portion of the taxes received in the 
Treasury under section 3201 as are attributable to 
the rate specified in section 3101(c) of such Code; 
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‘‘(3) such portion of the taxes received in the 
Treasury under section 3211 of such Code as are at-
tributable to the sum of the rates specified in section 
3101(c) and 3111(c) of such Code; and 
‘‘(4) such portion of the taxes received in the 
Treasury under section 3221 as are attributable to 
the rate specified in section 3111(c) of such Code. 
The amounts appropriated by the preceding sentence shall 
be transferred from time to time from the general fund 
in the Treasury to the Trust Fund, such amounts to be 
determined on the basis of estimates by the Secretary of 
the Treasury of the taxes, specified in the preceding sen-
tence, paid to or deposited into the Treasury, and proper 
adjustments shall be made in amounts subsequently trans-
ferred to the extent prior estimates were in excess of or 
were less than the taxes specified in such sentence. 
‘‘(c) INCORPORATION OF PROVISIONS.— 
‘‘(1) IN GENERAL.—Subject to paragraph (2), 
subsections (b) through (i) of section 1817 shall 
apply with respect to the Trust Fund and this title 
in the same manner as they apply with respect to 
the Federal Hospital Insurance Trust Fund and 
part A of title XVIII, respectively. 
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‘‘(2) MISCELLANEOUS REFERENCES.—In apply-
ing provisions of section 1817 under paragraph 
(1)— 
‘‘(A) any reference in such section to ‘this 
part’ is construed to refer to this title; 
‘‘(B) any reference to taxes referred to in 
subsection (a) of such section shall be construed 
to refer to the taxes referred to in subsection 
(b) of this section; and 
‘‘(C) the Board of Trustees of the Medi-
care for All Trust Fund shall be the same as 
the Board of Trustees of the Federal Hospital 
Insurance Trust Fund. 
‘‘SEC. 2206. ADMINISTRATION. 
‘‘Except as otherwise provided in this title— 
‘‘(1) the Secretary shall enter into appropriate 
contracts with providers of services, other health 
care providers, and medicare administrative contrac-
tors, taking into account, and based to the greatest 
extent practicable upon, the types of contracts used 
under title XVIII with respect to such entities, to 
administer the program under this title; 
‘‘(2) benefits described in section 2203 that are 
payable under the program under this title to such 
individuals shall be paid in a manner specified by 
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the Secretary (taking into account, and based to the 
greatest extent practicable upon, the manner in 
which they are provided under title XVIII); and 
‘‘(3) provider participation agreements under 
title XVIII shall apply to enrollees and benefits 
under the program under this title in the same man-
ner as they apply to enrollees and benefits under the 
program under title XVIII.’’. 
(b) CONFORMING AMENDMENTS TO SOCIAL SECU-
RITY ACT PROVISIONS.— 
(1) Section 201(i)(1) of the Social Security Act 
(42 U.S.C. 401(i)(1)) is amended— 
(A) by striking ‘‘or the Federal Supple-
mentary ’’ and inserting ‘‘the Federal Supple-
mentary’’; and 
(B) by inserting ‘‘or the Medicare for All 
Trust Fund’’ after ‘‘such 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 Supplementary Medical Insurance Trust 
Fund established by title XVIII, and the Medicare 
for All Trust Fund established under title XXII’’. 
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