for which the individual waives entitlement under 
part A of such title under paragraph (1). 
‘‘(4) TERMINATION OF WAIVER AND REENROLL-
MENT UNDER MEDICARE PROGRAM.—The Secretary 
shall establish a procedure under which an individual 
who waives entitlement under paragraph (1) may 
terminate such waiver during an annual period that 
shall be the same as the annual general enrollment 
period described in section 1837(e). For purposes of 
applying parts B and D of title XVIII, such indi-
vidual shall be treated as if the individual were enti-
tled to benefits under part A of such title as of the 
date such individual terminates the waiver under 
this paragraph. An individual who has terminated 
such a waiver may not subsequently make such a 
waiver. 
‘‘(l) MEDICARE
ALTERNATIVE
VOUCHER
PRO-
GRAM.— 
‘‘(1) ESTABLISHMENT OF PROGRAM.—The Sec-
retary shall establish a program to be known as the 
Medicare Alternative Voucher Program (in this sub-
section referred to as the ‘voucher program’) con-
sistent with this subsection. 
‘‘(2) AUTOMATIC ENROLLMENT.—An individual 
who waives entitlement under subsection (k)(1) shall 
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be enrolled in the voucher program for the period 
during which such waiver is in effect. 
‘‘(3) AMOUNT OF VOUCHER.— 
‘‘(A) AMOUNT BASED ON AGE COHORT.— 
‘‘(i) IN GENERAL.—Subject to clause 
(ii), for each month that an individual 
within an age cohort is enrolled in the 
voucher program, the Secretary shall pro-
vide a voucher to such individual in an 
amount that is equal to the monthly actu-
arial rate for that month computed under 
section 1818(d)(1) multiplied by the age 
cohort adjustment factor for such age co-
hort under subparagraph (B). 
‘‘(ii) MONTHLY LIMIT.—The amount 
of a voucher provided to an individual for 
a month may not exceed $200. 
‘‘(B) AGE
COHORT
ADJUSTMENT
FAC-
TOR.—For each age cohort the Secretary shall 
determine an age cohort adjustment factor 
equal to the ratio of— 
‘‘(i) the monthly actuarial rate de-
scribed in section 1818(d)(1) as deter-
mined by the Secretary for individuals in 
such age cohort, to 
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‘‘(ii) the monthly actuarial rate de-
scribed in such section. 
‘‘(C) AGE
COHORT
DEFINED.—For pur-
poses of this paragraph, an ‘age cohort’ means 
a group of individuals whose age falls within a 
span of five consecutive years, consistent with 
the following: 
‘‘(i) The first such span begins at age 
65. 
‘‘(ii) Other spans follow consecutively. 
‘‘(4) PERMISSIBLE
USE
OF
VOUCHER.—A 
voucher under paragraph (3) may be used only for 
the following purposes: 
‘‘(A) As a contribution into a health sav-
ings account established by such individual, as 
described in subsection (k)(1)(A). 
‘‘(B) For payment of premiums for enroll-
ment of such individual under a high deductible 
health plan described in such subsection. 
‘‘(5) EFFECT
OF
SUBSEQUENT
TERMINATION 
OF WAIVER.—If an individual terminates a waiver 
under subsection (k)(3), the enrollment of such indi-
vidual in the voucher program shall be terminated 
on the date on which the termination becomes effec-
tive.’’. 
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(b) AMENDMENT OF INTERNAL REVENUE CODE OF 
1986.—Paragraph (7) of section 223(b) of the Internal 
Revenue Code of 1986 (relating to Medicare eligible indi-
viduals) is amended to read as follows: 
‘‘(7) MEDICARE ELIGIBLE INDIVIDUALS.— 
‘‘(A) IN GENERAL.—The limitation under 
this subsection for any month with respect to 
an individual shall be zero for any month such 
individual is entitled to benefits under title 
XVIII of the Social Security Act. 
‘‘(B) MEDICARE
ALTERNATIVE
VOUCHER 
PROGRAM.—In the case of an individual who is 
enrolled in the Medicare Alternative Voucher 
Program under section 226(l) of the Social Se-
curity Act, the applicable limitation under sub-
paragraphs (A) and (B) of paragraph (2) shall 
be increased by the amount of the voucher de-
scribed in paragraph (3) of such section which 
is contributed to a health savings account of 
such individual.’’. 
(c) EFFECTIVE DATE.— 
(1) IN
GENERAL.—The amendment made by 
subsection (a) shall take effect on the date that is 
six months after the date of the enactment of this 
Act and shall apply to an individual who becomes 
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