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). 
VerDate Sep 11 2014 
03:46 Jul 10, 2021
Jkt 019200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H4148.IH
H4148
kjohnson on DSK79L0C42PROD with BILLS
‘‘(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 
VerDate Sep 11 2014 
03:46 Jul 10, 2021
Jkt 019200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H4148.IH
H4148
kjohnson on DSK79L0C42PROD with BILLS
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, 2022, and ends on December 31, 
2024, the Secretary shall award grants to eligible 
entities for the following purposes: 
‘‘(A) OUTREACH AND ENROLLMENT.—To 
carry out outreach, public education activities, 
VerDate Sep 11 2014 
03:46 Jul 10, 2021
Jkt 019200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H4148.IH
H4148
kjohnson on DSK79L0C42PROD with BILLS
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. 
VerDate Sep 11 2014 
03:46 Jul 10, 2021
Jkt 019200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6201
E:\BILLS\H4148.IH
H4148
kjohnson on DSK79L0C42PROD with BILLS
‘‘(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 
VerDate Sep 11 2014 
03:46 Jul 10, 2021
Jkt 019200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H4148.IH
H4148
kjohnson on DSK79L0C42PROD with BILLS