‘‘(4) INPUT.—The Secretary shall seek the 
input of the pediatric community in specifying and 
updating such benefits. 
‘‘(5) LIMITATION ON UPDATING.—In no case 
shall updating of benefits under this subsection re-
sult in a failure to provide benefits required under 
subsection (b). 
‘‘(b) INCLUSION OF CERTAIN BENEFITS.— 
‘‘(1) MEDICARE CORE BENEFITS.—Such bene-
fits shall include (to the extent consistent with other 
provisions of this section) at least the same benefits 
(including coverage, access, availability, duration, 
and beneficiary rights) that are available under 
parts A and B of title XVIII. 
‘‘(2) ALL
REQUIRED
MEDICAID
BENEFITS.— 
Such benefits shall also include all items and serv-
ices for which medical assistance is required to be 
provided under section 1902(a)(10)(A) to individuals 
described in such section, including early and peri-
odic screening, diagnostic services, and treatment 
services. 
‘‘(3) INCLUSION
OF
PRESCRIPTION
DRUGS.— 
Such benefits also shall include (as specified by the 
Secretary) benefits for prescription drugs and 
biologicals which are not less than the benefits for 
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such drugs and biologicals under the standard op-
tion for the service benefit plan described in section 
8903(1) of title 5, United States Code, offered dur-
ing 2007. 
‘‘(4) COST-SHARING.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), such benefits also shall include the 
cost-sharing (in the form of deductibles, coin-
surance, and copayments) which is substantially 
similar to such cost-sharing under the health 
benefits coverage in any of the four largest 
health benefits plans (determined by enroll-
ment) offered under chapter 89 of title 5, 
United States Code, and including an out-of- 
pocket limit for catastrophic expenditures for 
covered benefits, except that no cost-sharing 
shall be imposed with respect to early and peri-
odic screening and diagnostic services included 
under paragraph (2). 
‘‘(B) REDUCED
COST-SHARING
FOR
LOW 
INCOME CHILDREN.—Such benefits shall pro-
vide that— 
‘‘(i) there shall be no cost-sharing for 
children in families the income of which is 
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within the range described in section 
2201(f)(1)(A); 
‘‘(ii) the cost-sharing otherwise appli-
cable shall be reduced by 75 percent for 
children in families the income of which is 
within the range described in section 
2201(f)(1)(B); or 
‘‘(iii) the cost-sharing otherwise appli-
cable shall be reduced by 50 percent for 
children in families the income of which is 
within the range described in section 
2201(f)(1)(C). 
‘‘(C) CATASTROPHIC LIMIT ON COST-SHAR-
ING.—For a refundable credit for cost-sharing 
in the case of cost-sharing in excess of a per-
centage of the individual’s adjusted gross in-
come, see section 36 of the Internal Revenue 
Code of 1986. 
‘‘(c) PAYMENT SCHEDULE.—The Secretary, with the 
assistance of the Medicare Payment Advisory Commission, 
shall develop and implement a payment schedule for bene-
fits covered under this title. To the extent feasible, such 
payment schedule shall be consistent with comparable pay-
ment schedules and reimbursement methodologies applied 
under parts A and B of title XVIII. 
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‘‘(d) INPUT.—The Secretary shall specify such bene-
fits and payment schedules only after obtaining input from 
appropriate child health providers and experts. 
‘‘(e) ENROLLMENT IN HEALTH PLANS.—The Sec-
retary shall provide for the offering of benefits under this 
title through enrollment in a health benefit plan that 
meets the same (or similar) requirements as the require-
ments that apply to Medicare Advantage plans under part 
C of title XVIII (other than any such requirements that 
relate to part D of such title). In the case of individuals 
enrolled under this title in such a plan, the payment rate 
shall be based on payment rates provided for under section 
1853(c) in effect before the date of the enactment of the 
Medicare Prescription Drug, Modernization, and Improve-
ment Act of 2003 (Public Law 108–173), except that such 
payment rates shall be adjusted in an appropriate manner 
to reflect differences between the population served under 
this title and the population under title XVIII. 
‘‘SEC. 2203. PREMIUMS. 
‘‘(a) AMOUNT OF MONTHLY PREMIUMS.— 
‘‘(1) IN GENERAL.—The Secretary shall, during 
September of each year (beginning with 2008), es-
tablish a monthly MediKids premium for the fol-
lowing year. Subject to paragraph (2), the monthly 
MediKids premium for a year is equal to 1⁄12 of the 
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annual premium rate computed under subsection 
(b). 
‘‘(2) ELIMINATION OF MONTHLY PREMIUM FOR 
DEMONSTRATION
OF
EQUIVALENT
COVERAGE
(IN-
CLUDING
COVERAGE
UNDER
LOW-INCOME
PRO-
GRAMS).—The amount of the monthly premium im-
posed under this section for an individual for a 
month shall be zero in the case of an individual who 
demonstrates to the satisfaction of the Secretary 
that the individual has basic health insurance cov-
erage for that month. For purposes of the previous 
sentence enrollment in a medicaid plan under title 
XIX, a State child health insurance plan under title 
XXI, or under the medicare program under title 
XVIII is deemed to constitute basic health insurance 
coverage described in such sentence. 
‘‘(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 
2201(a)(1) as if all such individuals were eligible for 
(and enrolled) under this title during the entire year 
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