SEC. 2. MEDICARE PART B SPECIAL ENROLLMENT PERIOD 
FOR INDIVIDUALS ENROLLED IN COBRA CON-
TINUATION COVERAGE. 
(a) 
SPECIAL
ENROLLMENT
PERIOD.—Section 
1837(i) of the Social Security Act (42 U.S.C. 1395p(i)) 
is amended by adding at the end the following new para-
graph: 
‘‘(5)(A) In the case of an individual who— 
‘‘(i) at the time the individual first satisfies 
paragraph (1) or (2) of section 1836, is enrolled in 
COBRA continuation coverage (as defined in sub-
paragraph (D)), and 
‘‘(ii) has elected not to enroll (or to be deemed 
enrolled) under this section during the individual’s 
initial enrollment period, 
there shall be a special enrollment period described 
in subparagraph (B). 
‘‘(B) The special enrollment period referred to in sub-
paragraph (A) is the period including each month during 
any part of which the individual is enrolled in COBRA 
continuation coverage ending with the last day of the 
eighth consecutive month in which the individual is at no 
time so enrolled. 
‘‘(C) An individual may only enroll during the special 
enrollment period provided under subparagraph (B) one 
time during the individual’s lifetime. 
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‘‘(D) For purposes of this paragraph, the term 
‘COBRA continuation coverage’ means continuation cov-
erage provided pursuant to part 6 of subtitle B of title 
I of the Employee Retirement Income Security Act of 
1974 (other than under section 609), title XXII of the 
Public Health Service Act, section 4980B of the Internal 
Revenue Code of 1986 (other than subsection (f)(1) of 
such section insofar as it relates to pediatric vaccines), or 
section 8905a of title 5, United States Code, or under a 
State program that provides comparable continuation cov-
erage. Such term does not include coverage under a health 
flexible spending arrangement under a cafeteria plan with-
in the meaning of section 125 of the Internal Revenue 
Code of 1986.’’. 
(b) COVERAGE PERIOD.—Section 1838(e) of such 
Act (42 U.S.C. 1395q(e)) is amended— 
(1) by striking ‘‘pursuant to section 1837(i)(3) 
or 1837(i)(4)(B)’’ and inserting the following: 
‘‘pursuant to— 
‘‘(1) section 1837(i)(3) or 1837(i)(4)(B)—’’; 
(2) by redesignating paragraphs (1) and (2) as 
subparagraphs (A) and (B), respectively, and mov-
ing the indentation of each such subparagraph 2 
ems to the right; 
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(3) by striking the period at the end of the sub-
paragraph (B), as so redesignated, and inserting ‘‘; 
or’’; and 
(4) by adding at the end the following new 
paragraph: 
‘‘(2) section 1837(i)(5), the coverage period 
shall begin on the first day of the month following 
the month in which the individual so enrolls.’’. 
(c) NO INCREASE IN PREMIUM.—Section 1839(b) of 
such Act (42 U.S.C. 1395r(b)) is amended— 
(1) in the first sentence, by inserting ‘‘, (i)(5),’’ 
after ‘‘subsection (i)(4)’’; and 
(2) in the second sentence, by inserting before 
the period at the end the following: ‘‘or months for 
which the individual can demonstrate that the indi-
vidual was enrolled in COBRA continuation coverage 
(as such term is defined in section 1837(i)(5)(D)).’’. 
(d) EFFECTIVE DATE.— 
(1) IN GENERAL.—The amendments made by 
this section shall take effect on the date of the en-
actment of this Act and shall apply to periods of 
COBRA continuation coverage before, on, or after 
such date. 
(2) SPECIAL ENROLLMENT PERIOD.—No spe-
cial enrollment period under section 1837(i)(5)(B) of 
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the Social Security Act (42 U.S.C. 1395p(i)(5)(B)) 
shall begin before the first day of the first month 
that begins at least 45 days after the date of the en-
actment of this Act. 
(3) PREMIUMS.—The amendment made by sub-
section (c)(2) shall apply to premiums for months 
beginning with the first month that begins at least 
45 days after the date of the enactment of this Act. 
SEC. 3. CONTINUOUS OPEN MEDICARE PART B ENROLL-
MENT. 
(a) CONTINUOUS OPEN ENROLLMENT PERIOD.— 
Section 1837 of the Social Security Act (42 U.S.C. 1395p) 
is amended by adding at the end the following new sub-
section: 
‘‘(m)(1) There shall be a continuous open enrollment 
period beginning on the first day of the first month in 
which an individual first satisfies paragraph (1) or (2) of 
section 1836, except that such continuous open enrollment 
period shall not be available during the individual’s initial 
enrollment period or a special enrollment period available 
to the individual. 
‘‘(2) In the case of an individual seeking enrollment 
under paragraph (1) during a general enrollment period 
under subsection (e), the individual shall be enrolled under 
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such subsection and not under paragraph (1), unless the 
individual specifies otherwise.’’. 
(b) COVERAGE PERIOD.—Section 1838(a)(2) of such 
Act (42 U.S.C. 1395q(a)(2)) is amended— 
(1) in subparagraph (E), by striking the semi-
colon and inserting a comma; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(F) in the case of an individual who enrolls 
pursuant to subsection (m) of section 1837, the first 
day of the month following the month in which such 
individual so enrolls; or’’. 
(c) PREMIUM INCREASE.—Section 1839 of such Act 
(42 U.S.C. 1395r) is amended by adding at the end the 
following new subsection: 
‘‘(j) INCREASE IN PREMIUM BASED ON ENROLL-
MENT PURSUANT TO CONTINUOUS OPEN ENROLLMENT 
PERIOD.—In the case of an individual whose coverage pe-
riod began pursuant to a continuous open enrollment pe-
riod under section 1837(m), the monthly premium deter-
mined under subsection (a), adjusted in accordance with 
subsection (i), shall, in addition to the increase required 
by subsection (b), be increased by such amount as the Sec-
retary considers appropriate, taking into account any ad-
ditional actuarial cost to the insurance program estab-
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lished under this part due to enrollment under such sec-
tion. Any increase under this subsection shall apply to all 
premiums paid by the individual after enrollment pursuant 
to such continuous open enrollment period.’’. 
(d) REPORT TO CONGRESS.—Not later than 180 days 
after the date of the enactment of this Act, the Secretary 
of Health and Human Services shall submit to Congress 
a report describing— 
(1) the average increase in premiums based on 
enrollment in the insurance program established 
under part B of title XVIII of the Social Security 
Act pursuant to a continuous open enrollment period 
under section 1837(m) of such Act, as added by sub-
section (a); 
(2) any other regulations promulgated by the 
Secretary with respect to such enrollment; 
(3) the number and characteristics of individ-
uals choosing such enrollment; and 
(4) any costs of such enrollment to such insur-
ance program that were not covered by the increases 
in premiums described in the amendment made by 
subsection (c). 
(e) EFFECTIVE DATE.—The amendments made by 
this section shall take effect on the date of the enactment 
of this Act, except that no individual may enroll pursuant 
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to a continuous open enrollment period under the amend-
ment made by subsection (a) before the first day of the 
first month that begins at least 45 days after the date 
of the enactment of this Act. 
SEC. 4. SPECIAL ENROLLMENT PERIODS TO CORRECT 
ERROR, MISREPRESENTATION, OR INACTION 
OF FEDERAL GOVERNMENT, GROUP HEALTH 
PLAN, OR PLAN SPONSOR. 
Section 1837(h) of the Social Security Act (42 U.S.C. 
1395p(h)) is amended by inserting ‘‘or by an officer, em-
ployee, or agent of a group health plan, or of a plan spon-
sor (as such term is defined in section 3(16)(B) of the 
Employee Retirement Income Security Act of 1974 (29 
U.S.C. 1002(16)(B))) of a group health plan,’’ after ‘‘in-
strumentalities,’’. 
SEC. 5. COORDINATION OF MEDICARE PART B WITH AMER-
ICAN HEALTH BENEFIT EXCHANGES. 
Section 1837 of the Social Security Act (42 U.S.C. 
1395p), as amended by section 3(a), is further amended 
by adding at the end the following new subsection: 
‘‘(n) The Secretary shall ensure appropriate coordi-
nation between the insurance program established under 
this part and American Health Benefit Exchanges estab-
lished under section 1311(b) of the Patient Protection and 
Affordable Care Act (Public Law 111–148), including en-
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suring a smooth transition in enrollment from enrollment 
in qualified health plans offered through Exchanges to en-
rollment under this part.’’. 
SEC. 6. GAO STUDY AND REPORT ON MEDICARE PART B EN-
ROLLMENT. 
Not later than 2 years after the date of the enact-
ment of this Act, the Comptroller General of the United 
States shall submit to Congress a report on enrollment 
in the insurance program established under part B of title 
XVIII of the Social Security Act (in this section referred 
to as ‘‘Medicare part B’’). The report shall include— 
(1) a comprehensive evaluation of problems ex-
perienced by individuals with respect to enrollment 
in Medicare part B, including the causes of such 
problems and any geographic trends in the mani-
festation of such problems; 
(2) an assessment of the number of people who 
lack health insurance coverage because of such prob-
lems; 
(3) an evaluation of efforts by the Centers for 
Medicare & Medicaid Services and the Social Secu-
rity Administration to educate employers regarding 
the transition of employees from group health plans 
to Medicare part B; 
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(4) an evaluation of coordination of coverage 
for individuals with private health insurance who are 
also eligible for Medicare part B and ways to im-
prove such coordination; 
(5) an evaluation of the coordination between 
Medicare part B and American Health Benefit Ex-
changes required by the amendment made by section 
5; 
(6) an evaluation of the differences in regula-
tions applicable to individuals who are eligible for 
Medicare part B based on age and individuals who 
are eligible based on disability, and ways to improve 
parity in the treatment of each such group of indi-
viduals that may be implemented in regulations and 
guidance; and 
(7) an evaluation of efforts by the Centers for 
Medicare & Medicaid Services to provide equitable 
relief to individuals who suffered adverse con-
sequences due to misinformation or a lack of infor-
mation on enrollment in Medicare part B, and ways 
to improve the provision of such equitable relief. 
Æ 
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