in this subparagraph be subject to a late enroll-
ment penalty, which would otherwise be applied 
under section 1860E–32(c). 
‘‘(2) FLEXIBILITY IN USE OF SUBSIDIES.—An 
individual entitled to an amount of an income-re-
lated premium subsidy under paragraph (1) may use 
the amount of such subsidy toward the premium ap-
plied under Medicare fee-for-service or any MA–PD 
plan offered under any tier benefit level. 
‘‘(3) DEPOSIT
OF
EXCESS
INTO
HEALTH 
IRAS.—In the case of such an individual who is an 
account holder (as defined in section 201(2) of the 
Save and Strengthen Medicare Act of 2012) and for 
whom the subsidy amount under this subsection ex-
ceeds the premium amount which is applicable to the 
individual, the Medicare Choices Commission shall 
provide for the deposit of such excess amount into 
the health individual retirement account (as defined 
in section 201(1) of such Act) of such account hold-
er.’’. 
(d) APPLICATION OF REVISED INCOME THRESHOLDS 
TO PART D.—Section 1860D–13(a)(7) of the Social Secu-
rity Act (42 U.S.C. 1395w–113(a)(7)) is amended— 
(1) in subparagraph (A), by inserting ‘‘(or, for 
a calendar year after 2015, the threshold amount 
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applicable under paragraph (1) of section 1860E– 
41(a) (including application of paragraph (4) of 
such section) for the calendar year)’’ after ‘‘for the 
calendar year’’; 
(2) in subparagraph (B)— 
(A) in the matter preceding clause (i), by 
striking ‘‘The monthly’’ and inserting ‘‘Subject 
to subparagraph (H), the monthly’’; and 
(B) in clause (i)(I), by inserting ‘‘(or, for 
a calendar year after 2015, the applicable per-
centage that would be determined under para-
graph (2) of section 1860E–41(a) (including 
application of paragraph (4) of such section) 
for the individual for the calendar year if the 
table specified in subparagraph (G) were sub-
stituted for the table specified in the table 
under such paragraph (2))’’ after ‘‘for the cal-
endar year’’; 
(3) in subparagraph (E)(ii)— 
(A) in subclause (I), by inserting ‘‘or, for 
a year after 2015, the modified adjusted gross 
income threshold amount applicable under para-
graph (1) of section 1860E–41(a) (including 
application of paragraph (4) of such section)’’ 
before the period at the end; and 
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(B) in subclause (II), by inserting ‘‘or, for 
a year after 2015, the applicable percentage 
that would be determined under paragraph (2) 
of section 1860E–41(a) (including application 
of paragraph (4) of such section) if the table 
specified in subparagraph (G) were substituted 
for the table specified in the table under such 
paragraph (2))’’ before the period at the end; 
and 
(4) by adding at the end the following new sub-
paragraphs: 
‘‘(G) TABLE.—For purposes of subpara-
graph (B)(i)(I), the table specified in this sub-
paragraph is as follows: 
‘‘Initial Income Level 
within 
Tier for Individual 
(or Couple) 
Final Income Level 
within 
Tier for Individual 
(or Couple) 
Initial 
Premium 
Percentage 
Final 
Premium 
Percentage 
$50,000 ($100,000) 
$85,000 ($150,000)
25 percent 
35 percent
$85,001 ($150,001) 
$130,000 ($214,000) 
35 percent 
50 percent
$130,001 ($214,001) 
$190,000 ($300,000) 
50 percent 
80 percent
$190,001 ($300,001) 
No Limit ...................
80 percent 
80 percent. 
‘‘(H) TRANSITION
FOR
CERTAIN
SEN-
IORS.—In the case of individuals and couples 
with an income level that is below the minimum 
level for which section 1839(i) (as in effect as 
of the date of enactment of this subparagraph) 
would otherwise apply before application of the 
amendments made by section 106(b) of the 
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Save and Strengthen Medicare Act of 2012, the 
monthly adjustment amount to be applied 
under subparagraph (B) for such an individual 
for a month in a fiscal year shall be the transi-
tion percentage specified in section 1860E– 
41(a)(3)(B) for such fiscal year of the monthly 
adjustment amount otherwise specified under 
such subparagraph.’’. 
SEC. 107. MEDICARE CHOICES COMMISSION; GENERAL 
PROVISIONS; EFFECTIVE DATE. 
Part E of title XVIII of the Social Security Act, as 
inserted by section 101(a)(2) and as previously amended, 
is further amended by adding at the end the following new 
subpart: 
‘‘Subpart 5—Medicare Choices Commission 
‘‘SEC. 1860E–51. MEDICARE CHOICES COMMISSION. 
‘‘(a) ESTABLISHMENT.—Subject to subsection (d), 
there is established as an independent agency of the 
United States a Medicare Commission (in this part re-
ferred to as the ‘Medicare Choices Commission’). 
‘‘(b) MEMBERSHIP.— 
‘‘(1) NUMBER AND APPOINTMENT.—The Medi-
care Choices Commission shall be composed of 7 
members appointed by the President, by and with 
the advice and consent of the Senate. 
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‘‘(2) DEADLINE FOR INITIAL APPOINTMENT.— 
The initial members of the Commission shall be 
nominated for appointment by not later than 6 
months after the date of enactment of this title. 
‘‘(3) TERMS.— 
‘‘(A) IN GENERAL.—The terms of mem-
bers of the Commission shall be for 7 years, ex-
cept that of the members first appointed— 
‘‘(i) 3 shall be appointed for terms of 
3 years; 
‘‘(ii) 2 shall be appointed for terms of 
5 years; and 
‘‘(iii) 2 shall be appointed for terms of 
7 years. 
‘‘(B) VACANCIES.—Any member appointed 
to fill a vacancy occurring before the expiration 
of the term for which the member’s predecessor 
was appointed shall be appointed only for the 
remainder of that term. A member may serve 
after the expiration of that member’s term until 
a successor has taken office. 
‘‘(C) 
LIMITATION
ON
NUMBER
OF 
TERMS.—Any person appointed as a member of 
the Commission shall not be eligible for re-
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appointment to the Commission after having 
served 2 terms. 
‘‘(4) CHAIRPERSON
AND
OTHER
OFFICERS.— 
The Commission shall elect a chairperson and such 
officers as the Commission determines appropriate. 
‘‘(c) OPERATION OF THE BOARD.— 
‘‘(1) MEETINGS.—The Commission shall meet 
at the call of its chairperson or a majority of its 
members. 
‘‘(2) QUORUM.—A quorum shall consist of 4 
members of the Commission, except that the Com-
mission may establish a lesser quorum to conduct a 
hearing under section 2243(a). 
‘‘(d) ASSURING TIMELY IMPLEMENTATION OF COM-
MISSION.—If, by not later than one year after the date 
of the enactment of this subpart, the Senate has not con-
sented to a quorum of initial members of the Commission 
under subsection (b), the duties and powers of the Com-
mission under this part shall be carried out by the Office 
of the Actuary of the Centers for Medicare & Medicaid 
Services. 
‘‘SEC. 1860E–52. DUTIES OF THE COMMISSION. 
‘‘(a) IN GENERAL.—Except as otherwise provided in 
this title and effective with respect to benefits furnished 
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on or after January 1, 2015, the Medicare Choices Com-
mission shall— 
‘‘(1) coordinate determinations of beneficiary 
eligibility and enrollment under title XVIII with the 
Administrator of Social Security; 
‘‘(2) oversee and administer the competitive 
bidding under subpart 3; 
‘‘(3) oversee and administer the provisions of 
part C; 
‘‘(4) oversee and administer the provisions of 
part D; 
‘‘(5) distribute funds in appropriate part from 
the Federal Hospital Insurance Trust Fund under 
section 1817 and the Federal Supplementary Med-
ical Insurance Trust Fund under section 1841; 
‘‘(6) oversee and enforce the provisions of sec-
tion 1851(g) (relating to guaranteed issue and re-
newal), as applied through this part, including to en-
sure a Medicare Advantage organization offering an 
MA–PD plan does not impose under such plan an 
exclusion of benefits based on a pre-existing condi-
tion; 
‘‘(7) disseminate to Medicare enrollees informa-
tion with respect to benefits and limitations on pay-
ment under Medicare fee-for-service and Medicare 
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Advantage plans, including a comparative analysis of 
Medicare plans and the quality of such plans in the 
area in which the Medicare beneficiary resides; 
‘‘(8) establish a Medicare enrollee education 
program to provide timely, readable, accurate, and 
understandable information to Medicare enrollees re-
garding Medicare fee-for-service and Medicare Ad-
vantage plan options; 
‘‘(9) coordinate and maintain the Medicare.gov 
Internet Web site; and 
‘‘(10) conduct public outreach and education ef-
forts in accordance with section 301 of the Save and 
Strengthen Medicare Act of 2012. 
‘‘(b) RELATION TO MEDICARE FEE-FOR-SERVICE.— 
The Commission shall not be responsible for the operation 
of Medicare fee-for-service, but shall have oversight au-
thority over Medicare fee-for-service in a similar manner 
to that provided with respect to Medicare Advantage 
plans. 
‘‘(c) TRANSITION PROVISIONS.—The Secretary and 
the Commission shall cooperate to establish an appro-
priate transition of responsibility for the administration 
of title XVIII and other related laws, from the Secretary 
to the Commission as is appropriate to carry out the pur-
poses of this part and as is consistent with the duties of 
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the Commission described in subsection (a). Insofar as a 
responsibility is transferred to the Commission under this 
subsection, any reference to the Secretary or the Centers 
of Medicare & Medicaid Services in title XVIII or other 
provision of law with respect to such responsibility is 
deemed to be a reference to the Commission. 
‘‘SEC. 1860E–53. POWERS OF COMMISSION. 
‘‘(a) IN GENERAL.—The Medicare Choices Commis-
sion may, for the purpose of carrying out its duties, pro-
mulgate regulations, hold hearings, sit and act at times 
and places, take testimony, and receive evidence as the 
Commission considers appropriate. 
‘‘(b) CONTRACT AUTHORITY.—The Commission may 
contract with, and compensate, government and private 
agencies or persons for items and services, without regard 
to section 3709 of the Revised Statutes (41 U.S.C. 5). 
‘‘(c) COMMISSION AUTHORITY TO PERMIT FLEXI-
BILITY IN REQUIREMENTS.—In promulgating regulations 
under subsection (a) to carry out the requirements of part 
C of title XVIII, the Commission may modify the regula-
tions previously promulgated by the Secretary to carry out 
such requirements (other than those relating to benefits 
or beneficiary protections) as may be appropriate to better 
meet the needs of Medicare enrollees and promote fair and 
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open competition among Medicare fee-for-service and 
Medicare Advantage plans. 
‘‘(d) OVERSEEING SOLVENCY OF MEDICARE FEE- 
FOR-SERVICE.—The Commission shall monitor and over-
see the financial solvency of Medicare fee-for-service in a 
manner similar to the manner in which State insurance 
commissioners monitor and oversee the solvency of health 
insurance issuers in the States. The Commission shall in-
clude in its periodic reports to Congress an analysis of 
the solvency of Medicare fee-for-service. 
‘‘SEC. 1860E–54. COMMISSION PERSONNEL MATTERS. 
‘‘(a) MEMBERS.— 
‘‘(1) COMPENSATION.—Members of the Medi-
care Choices Commission shall devote their entire 
time to the business of the Commission, and each 
member shall be compensated at a rate equal to the 
per diem equivalent of the rate provided for level II 
of the Executive Schedule under section 5315 of title 
5, United States Code. 
‘‘(2) TRAVEL EXPENSES.—The members of the 
Commission shall be allowed travel expenses, includ-
ing per diem in lieu of subsistence, at rates author-
ized for employees of agencies under subchapter I of 
chapter 57 of title 5, United States Code, while 
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100 
away from their homes or regular places of business 
in the performance of service for the Commission. 
‘‘(3) REMOVAL.—The President may remove a 
member of the Commission only for neglect of duty 
or malfeasance in office. 
‘‘(b) STAFF AND SUPPORT SERVICES.— 
‘‘(1) EXECUTIVE DIRECTOR.—The chairperson 
shall appoint an executive director of the Commis-
sion who shall be paid at a rate specified by the 
Commission. 
‘‘(2) STAFF.—With the approval of the Com-
mission, the executive director may appoint such 
personnel as the executive director considers appro-
priate. 
‘‘(3) 
INAPPLICABILITY
OF
CIVIL
SERVICE 
LAWS.—The staff of the Commission shall be ap-
pointed without regard to the provisions of title 5, 
United States Code, governing appointments in the 
competitive service, and shall be paid without regard 
to the provisions of chapter 51 and subchapter III 
of chapter 53 of such title (relating to classification 
and General Schedule pay rates). 
‘‘(4) EXPERTS AND CONSULTANTS.—With the 
approval of the Commission, the executive director 
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101 
may procure temporary and intermittent services 
under section 3109(b) of title 5, United States Code. 
‘‘(c) TRANSFER OF PERSONNEL, ASSETS, ETC.—For 
purposes of the Commission carrying out its duties, the 
Secretary and the Commission may provide for the trans-
fer to the Commission of such civil service personnel em-
ployed by the Department of Health and Human Services, 
and such resources and assets of the Department used in 
carrying out title XVIII, as the Commission requires. 
‘‘SEC. 1860E–55. REPORTS; COMMUNICATIONS WITH CON-
GRESS. 
‘‘(a) REPORT ON MEDICARE PROGRAM.—Not less 
frequently than annually, the Medicare Choices Commis-
sion shall submit to Congress such reports describing the 
Medicare program under title XVIII as the Commission 
determines appropriate. 
‘‘(b) MAINTAINING INDEPENDENCE OF COMMISSION 
IN COMMUNICATIONS WITH CONGRESS.—The Commis-
sion may directly submit to Congress reports, legislative 
recommendations, testimony, or comments on legislation. 
No officer or agency of the United States may require the 
Commission to submit to any officer or agency of the 
United States for approval, comments, or review, prior to 
the submission to Congress of such reports, recommenda-
tions, testimony, or comments. 
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102 
‘‘SEC. 1860E–56. FUNDING OF THE COMMISSION. 
‘‘There is authorized to be appropriated to the Medi-
care Choices Commission (in appropriate part from the 
Federal Hospital Insurance Trust Fund under section 
1817 and the Federal Supplementary Medical Insurance 
Trust Fund under section 1841) such sums as are nec-
essary for the Commission to carry out its duties for each 
fiscal year beginning with fiscal year 2014. 
‘‘Subpart 6—General Provisions 
‘‘SEC. 1860E–61. APPLICABILITY; DEFINITIONS. 
‘‘(a) IN GENERAL.—The provisions of this Act are 
superseded to the extent inconsistent with the provisions 
of this part. 
‘‘(b) TERMINOLOGY.—For purposes of this part: 
‘‘(1) MEDICARE ENROLLEE.— 
‘‘(A) IN
GENERAL.—The term ‘Medicare 
enrollee’ means— 
‘‘(i) an individual entitled to (or en-
rolled for benefits) under part A and en-
rolled under part B; and 
‘‘(ii) except as otherwise specified, an 
individual described in section 1860E– 
11(a)(3). 
‘‘(B) TREATMENT.—Any reference in this 
Act (or any other Act) in effect before the date 
of the enactment of this part, to an individual 
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103 
entitled to benefits under part A or enrolled 
under part B shall be deemed a reference to a 
Medicare enrollee. 
‘‘(2) MEDICARE FEE-FOR-SERVICE.—The term 
‘Medicare fee-for-service’ means the original Medi-
care fee-for-service program under parts A and B, 
as modified by this part, and does not include part 
C or part D. 
‘‘(3) 
MEDICARE
FEE-FOR-SERVICE
EN-
ROLLEE.—The term ‘Medicare fee-for-service en-
rollee’ means a Medicare enrollee who is not enrolled 
under a Medicare Advantage plan under part C. 
‘‘SEC. 1860E–62. GENERAL EFFECTIVE DATE. 
‘‘Except as otherwise specified, the provisions of this 
part shall apply to items and services furnished on or after 
January 1, 2016, and to plan years beginning on or after 
such date (referred to in this title as the ‘general effective 
date’).’’. 
TITLE II—HEALTH INDIVIDUAL 
RETIREMENT ACCOUNTS 
Subtitle A—Establishment of 
Accounts 
SEC. 201. DEFINITIONS. 
For purposes of this subtitle— 
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104 
(1) HEALTH
INDIVIDUAL
RETIREMENT
AC-
COUNT.—The term ‘‘health individual retirement ac-
count’’ means an account established under section 
203. 
(2) ACCOUNT
HOLDER.—The term ‘‘account 
holder’’ means any individual for whom an account 
is established under section 203. 
(3) HIRA FUND.—The term ‘‘HIRA Fund’’ 
means the Health Individual Retirement Account 
Fund established under section 202. 
SEC. 202. HEALTH INDIVIDUAL RETIREMENT ACCOUNT 
FUND. 
(a) ESTABLISHMENT OF FUND.— 
(1) ESTABLISHMENT.—There is established in 
the Treasury of the United States a trust fund to 
be known as the Health Individual Retirement Ac-
count Fund. 
(2) AMOUNTS
IN
FUND.—The HIRA Fund 
shall consist of all amounts contributed to the HIRA 
Fund under section 204, increased by the total net 
earnings from investments of sums in the HIRA 
Fund attributable to such contributed amounts, and 
reduced by the total net losses from investments of 
such sums. 
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105 
(3) TRUSTEES.—The Commissioner of Social 
Security shall serve as trustee of the HIRA Fund. 
(4) BUDGET
AUTHORITY; APPROPRIATION.— 
This subtitle constitutes budget authority in advance 
of appropriations Acts and represents the obligation 
of the Commissioner to provide for the payment of 
amounts provided under this subtitle. The amounts 
held in the HIRA Fund are appropriated and shall 
remain available without fiscal year limitation. 
(b) AVAILABILITY.—The sums in the HIRA Fund are 
appropriated and shall remain available without fiscal year 
limitation— 
(1) to invest funds in the HIRA Fund under 
section 205; 
(2) to make distributions in accordance with 
section 206; and 
(3) to pay the administrative expenses of the 
Board in accordance with subsection (d). 
(c) LIMITATIONS ON USE OF FUNDS.— 
(1) IN GENERAL.—Sums in the HIRA Fund 
credited to a account holder’s health individual re-
tirement account under section 205(a)(1)(2) may 
not be used for, or diverted to, purposes other than 
for the exclusive benefit of the account holder or the 
account holder’s beneficiaries under this subtitle. 
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106 
(2) ASSIGNMENTS.—Sums in the HIRA Fund 
may not be assigned or alienated and are not subject 
to execution, levy, attachment, garnishment, or other 
legal process. 
(d) PAYMENT OF ADMINISTRATIVE EXPENSES.—Ad-
ministrative expenses incurred to carry out this subtitle 
shall be paid out of net earnings in the HIRA Fund in 
conjunction with the allocation of investment earnings and 
losses under section 203(d). 
(e) LIMITATION.—The sums in the HIRA Fund shall 
not be appropriated for any purpose other than the pur-
poses specified in this part and may not be used for any 
other purpose. 
SEC. 203. ESTABLISHMENT OF HEALTH INDIVIDUAL RE-
TIREMENT ACCOUNTS. 
(a) ESTABLISHMENT OF PUBLICLY ADMINISTERED 
SYSTEM
OF
HEALTH
INDIVIDUAL
RETIREMENT
AC-
COUNTS.—The Commissioner shall establish a health indi-
vidual account for each individual who— 
(1) receives wages in any calendar year after 
December 31, 2015, subject to the contribution re-
quirement of section 3101(a) of the Internal Rev-
enue Code of 1986; 
(2) derives self-employment income for a tax-
able year beginning after December 31, 2015, sub-
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107 
ject to the contribution requirement of section 
1401(a) of such Code; or 
(3) is a Medicare enrollee (as defined in section 
1860E–61(b) of the Social Security Act). 
(b) MANAGEMENT
OF ACCOUNTS.—Such account 
shall be the means by which amounts contributed to, and 
held in, the HIRA Fund under section 204 are credited 
to the account holder, under procedures which shall be es-
tablished by the Commissioner by regulation. Each ac-
count shall be identified to the account holder by means 
of the account holder’s social security account number. 
The Commissioner shall take such steps as are necessary 
to protect account holders’ social security numbers, includ-
ing not using complete social security numbers on any 
statements or identification or payment cards. 
(c) ACCOUNT BALANCE.—The balance in an account 
holder’s account at any time is the excess of— 
(1) all deposits in the HIRA Fund credited to 
such account holder’s health individual retirement 
account, subject to such increases and reductions as 
may result from allocations made to and reductions 
made in the account pursuant to subsection (d); over 
(2) amounts paid out of the HIRA Fund in 
connection with amounts credited to such account 
holder’s account. 
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108 
(d) ALLOCATION OF EARNINGS AND LOSSES.—Pur-
suant to regulations which shall be prescribed by the Com-
missioner, the Commissioner shall allocate to each health 
individual retirement account an amount equal to the net 
earnings and net losses from each investment of sums in 
the HIRA Fund which are attributable to sums credited 
to such account reduced by an appropriate share of the 
administrative expenses paid out of the net earnings, as 
determined by the Commissioner. 
SEC. 204. TRANSFER OF HIRA CONTRIBUTIONS TO HIRA 
FUND. 
(a) IN GENERAL.—There is hereby appropriated to 
the HIRA Fund, out of moneys in the Treasury not other-
wise appropriated, amounts equivalent to 100 percent of 
amounts contributed under sections 3101(d) and 1401(d) 
of the Internal Revenue Code of 1986. The Secretary of 
the Treasury shall from time to time transfer such 
amounts from the general fund in the Treasury to the 
HIRA Fund. 
(b) CONTRIBUTIONS FROM HHS.—The Commis-
sioner shall accept any contributions with respect to an 
account holder’s account, including contributions from the 
Secretary of Health and Human Services under sections 
1860E–25 and 1860E–41(b)(3) of the Social Security Act 
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109 
and any contribution from a State under section 1944(b) 
of such Act. 
(c) COORDINATION WITH SOCIAL SECURITY TRUST 
FUNDS.—The 
amounts 
contributed 
under 
sections 
3101(d) and 1401(d) of such Code shall not be taken into 
account in determining the amounts appropriated and 
transferred under section 201 of the Social Security Act. 
SEC. 205. OPERATION OF HIRA FUND. 
(a) SEPARATE CREDITING TO HEALTH INDIVIDUAL 
RETIREMENT ACCOUNTS.— 
(1) IN GENERAL.—Subject to this subsection, 
the Commissioner shall provide for prompt, separate 
crediting of the amounts deposited in the HIRA 
Fund to each account holder’s health individual sav-
ings account to the extent such amount consists of 
contributions made to the HIRA Fund under section 
204 with respect to such account holder, together 
with any increases or decreases therein so as to re-
flect the net returns and losses from investment 
thereof while held in the Fund. 
(2) USE OF FUNDS.—The amounts held in the 
Fund are appropriated and shall remain available 
without fiscal year limitation— 
(A) to be held for investment under sub-
section (b), and 
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110 
(B) to pay the administrative expenses re-
lated to the HIRA Fund. 
(b) INVESTMENT GUIDELINES.— 
(1) IN GENERAL.—For purposes of investment 
of amounts credited to each health individual retire-
ment account, the Commissioner shall provide by 
regulation for investment options similar to invest-
ment options available under the Thrift Savings 
Fund under section 8438 of title 5, United States 
Code. 
(2) 
ELECTIONS
AMONG
INVESTMENT
OP-
TIONS.—Pursuant to any individual’s election filed 
in accordance with regulations of the Commissioner, 
the Commissioner shall, in accordance with such reg-
ulations, provide for disinvestment and reinvestment 
of amounts credited to the account holder’s health 
individual retirement account and held in the HIRA 
Fund under any of the investment options described 
in paragraph (1). 
(3) SPECIAL
RULE
FOR
INVESTING
CERTAIN 
AMOUNTS CONTRIBUTED FROM HHS.—Amounts con-
tributed to any account by the Secretary of Health 
and Human Services under section 1860E–25 of the 
Social Security Act may be invested only in the in-
vestment option established under paragraph (1) 
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111 
that is the equivalent to the Government Securities 
Investment 
Fund 
(as 
defined 
under 
section 
8438(a)(4) of title 5, United States Code). 
(c) ANNUAL DESCRIPTION OF INVESTMENT OPTIONS 
AND
DISCLOSURE
OF
ADMINISTRATIVE
COSTS.—The 
Commissioner shall provide annually to each account hold-
er— 
(1) a description of the investment options 
available with respect to amounts held in the HIRA 
Fund and the procedures for selecting such options; 
and 
(2) a disclosure of the rate of administrative 
costs chargeable with respect to each investment op-
tion. 
Descriptions and disclosures required under this sub-
section shall be written in a manner calculated to be un-
derstood by the average account holder. 
(d) ACCOUNT
INFORMATION.—The Commissioner 
shall create an online portal that enables account holders 
to view their account information, modify investment allo-
cations, and request quarterly paper account statements. 
(e) TREATMENT
OF AMOUNTS HELD
IN HIRA 
FUND.—Subject to this subtitle and to the extent provided 
in section 1860E–25(c)(2) of the Social Security Act with 
respect to amounts contributed under such section, 
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112 
amounts deposited into, and held and accounted for in, 
the HIRA Fund with respect to any account holder shall 
be treated as property of such account holder, held in trust 
for such account holder in the Fund. 
SEC. 206. HEALTH INDIVIDUAL RETIREMENT ACCOUNT DIS-
TRIBUTIONS. 
(a) IN GENERAL.—The Commissioner may distribute 
amounts from an account holder’s health individual retire-
ment account only— 
(1) for qualified medical expenses (as defined in 
section 530A(d)(1) of the Internal Revenue Code of 
1986); 
(2) to an individual’s spouse or former spouse 
under a divorce or separation instrument described 
in subparagraph (A) of section 71(b)(2) of such 
Code; 
(3) by a transfer at the death of the account 
holder as provided under subsection (b); or 
(4) as provided in section 1860E–25(c)(2) of 
the Social Security Act. 
(b) SPECIAL
ACCOUNTING
RULE
FOR
CERTAIN 
AMOUNTS.—Each calendar year, any distributions from 
an account shall be treated as— 
(1) first from any amounts contributed to the 
account for such calendar year by the Secretary of 
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113 
Health and Human Services under section 1860E– 
25 of the Social Security Act, and 
(2) then from all other amounts credited to the 
account. 
(c) TREATMENT AT DEATH.—If the account holder 
dies before all amounts which are held in the HIRA Fund 
which are credited to the health individual retirement ac-
count of the individual are otherwise distributed in accord-
ance with this section, such amounts shall be distributed, 
under regulations which shall be prescribed by the Com-
missioner— 
(1) in any case in which one or more bene-
ficiaries have been designated in advance, to such 
beneficiaries in accordance with such designation as 
provided in such regulations; and 
(2) in the case of any amount not distributed 
as described in paragraph (1), to such individual’s 
estate. 
Subtitle B—Tax Treatment 
SEC. 211. TAX TREATMENT OF ACCOUNTS. 
(a) IN GENERAL.—Subchapter F of chapter 1 of the 
Internal Revenue Code of 1986 (relating to exempt organi-
zations) is amended by adding at the end the following 
new part: 
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114 
‘‘PART IX—HEALTH INDIVIDUAL RETIREMENT 
ACCOUNT PROGRAM 
‘‘Sec. 530A. Health Individual Retirement Account Program. 
‘‘SEC. 530A. HEALTH INDIVIDUAL RETIREMENT ACCOUNT 
PROGRAM. 
‘‘(a) TAX TREATMENT OF ACCOUNTS.—The Health 
Individual Retirement Account Fund is exempt from tax-
ation under this subtitle. 
‘‘(b) TREATMENT OF DISTRIBUTIONS.— 
‘‘(1) EXCLUSION
OF
AMOUNTS
USED
FOR 
QUALIFIED MEDICAL EXPENSES.—Any amount paid 
or distributed out of a health individual retirement 
account which is used exclusively to pay qualified 
medical expenses of the account beneficiary shall not 
be includible in gross income. 
‘‘(2) INCLUSION OF AMOUNTS NOT USED FOR 
QUALIFIED MEDICAL EXPENSES.—Any amount paid 
or distributed out of a health individual retirement 
account which is used other than as described in 
paragraph (1) shall be included in the gross income 
of the account beneficiary. 
‘‘(3) ADDITIONAL TAX ON DISTRIBUTIONS NOT 
USED
FOR
QUALIFIED
MEDICAL
EXPENSES.—The 
tax imposed by this chapter on the account bene-
ficiary for any taxable year in which there is a pay-
ment or distribution from a health savings account 
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115 
of such beneficiary which is includible in gross in-
come under paragraph (2) shall be increased by 10 
percent of the amount which is so includible. 
‘‘(4) COORDINATION WITH MEDICAL EXPENSE 
DEDUCTION.—For purposes of determining the 
amount of the deduction under section 213, any pay-
ment or distribution out of a health individual retire-
ment account for qualified medical expenses shall 
not be treated as an expense paid for medical care. 
‘‘(5) TRANSFER OF ACCOUNT INCIDENT TO DI-
VORCE.—The transfer of an individual’s interest in 
a health individual retirement account to an individ-
ual’s spouse or former spouse under a divorce or 
separation instrument described in subparagraph 
(A) of section 71(b)(2) shall not be considered a tax-
able transfer made by such individual notwith-
standing any other provision of this subtitle, and 
such interest shall, after such transfer, be treated as 
a health individual retirement account with respect 
to which such spouse is the account beneficiary. 
‘‘(6) TREATMENT AFTER DEATH OF ACCOUNT 
BENEFICIARY.— 
‘‘(A) IN GENERAL.—The transfer of an ac-
count beneficiary’s interest in a health indi-
vidual retirement account to another individual 
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116 
by reason of being the designated beneficiary of 
such account at the death of the account bene-
ficiary shall not be considered a taxable transfer 
made by such individual notwithstanding any 
other provision of this title. 
‘‘(B) OTHER CASES.—In the case of any 
other transfer or acquisition of account bene-
ficiary’s interest at the death of the account 
beneficiary, an amount equal to the fair market 
value of the assets in such account as of the 
date of death shall be includible in such bene-
ficiary’s gross income for the last taxable year 
of such beneficiary. 
‘‘(c) ESTATE TAX TREATMENT.—No amount shall be 
includible in the gross estate of any individual for pur-
poses of chapter 11 by reason of an interest in a health 
individual retirement account of the individual. 
‘‘(d) DEFINITIONS.—For purposes of this section— 
‘‘(1) QUALIFIED
MEDICAL
EXPENSES.—The 
term ‘qualified medical expenses’ means, with re-
spect to an account beneficiary, amounts paid for 
medical care (as defined in section 213(d)) for such 
individual, the individual’s spouse, and any depend-
ent (as defined in section 152, determined without 
regard to subsections (b)(1), (b)(2), and (d)(1)(B) 
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117 
thereof) of the individual, but only to the extent 
such amounts are not compensated for by insurance 
or otherwise and only if the individual, spouse, or 
dependent with respect to whom the amount is paid 
is entitled, at the time the amount is paid, to a 
monthly benefit under title II of the Social Security 
Act or a tier 1 railroad retirement benefit. 
‘‘(2) 
ABORTION
AND
EUTHANASIA
EX-
CLUDED.— 
‘‘(A) IN GENERAL.—Such term shall not 
include any amount paid for an abortion or for 
the purposeful causing of, or the purposeful as-
sisting in causing, the death of any individual, 
such as by assisted suicide, euthanasia, or 
mercy killing. 
‘‘(B) 
EXCEPTIONS.—Subparagraph 
(A) 
shall not apply to— 
‘‘(i) an abortion— 
‘‘(I) in the case of a pregnancy 
that is the result of an act of rape or 
incest, or 
‘‘(II) in the case where a woman 
suffers from a physical disorder, phys-
ical injury, or physical illness that 
would, as certified by a physician, 
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118 
place the woman in danger of death 
unless an abortion is performed, in-
cluding a life-endangering physical 
condition caused by or arising from 
the pregnancy, and 
‘‘(ii) the treatment of any infection, 
injury, disease, or disorder that has been 
caused by or exacerbated by the perform-
ance of an abortion. 
‘‘(3) ACCOUNT
BENEFICIARY.—The term ‘ac-
count beneficiary’ means the account holder (as de-
fined in section 201 of the Save and Strengthen 
Medicare Act of 2012) on whose behalf the health 
individual retirement account is held. 
‘‘(4) HEALTH
INDIVIDUAL
RETIREMENT
AC-
COUNT.—The term ‘health individual retirement ac-
count’ means an account established under section 
203(b) of the Save and Strengthen Medicare Act of 
2012. 
‘‘(5) HEALTH
INDIVIDUAL
RETIREMENT
AC-
COUNT FUND.—The term ‘Health Individual Retire-
ment Account Fund’ means the Fund established 
under section 202 of the Save and Strengthen Medi-
care Act of 2012.’’. 
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119 
(b) CLERICAL AMENDMENT.—The table of parts for 
subchapter F of chapter 1 of such Code is amended by 
adding at the end the following new item: 
‘‘PART IX. HEALTH INDIVIDUAL RETIREMENT ACCOUNT PROGRAM’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to taxable years beginning after 
December 31, 2015. 
SEC. 212. HIRA CONTRIBUTIONS. 
(a) EMPLOYMENT.— 
(1) IN GENERAL.—Section 3101 of the Internal 
Revenue Code of 1986 is amended by adding at the 
end the following new subsection: 
‘‘(d) 
HEALTH
INDIVIDUAL
RETIREMENT
AC-
COUNTS.— 
‘‘(1) IN GENERAL.—In addition to the taxes im-
posed by subsections (a) and (b), there shall be de-
ducted and withheld from the income of every indi-
vidual an amount equal to the applicable percentage 
of wages (as defined in section 3121(a)) received by 
him with respect to employment during any taxable 
year. 
‘‘(2) LIMITATION.—The amount deducted and 
withheld under paragraph (1) shall not exceed 
$2,500 ($5,000 in the case of a married couple filing 
jointly) for any taxable year. 
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120 
‘‘(3) APPLICABLE PERCENTAGE.—For purposes 
of this subsection, the applicable percentage shall be 
2 percent, or such other percentage (including zero) 
as the individual elects in such form and manner as 
the Secretary shall prescribe. 
‘‘(4) INFLATION ADJUSTMENT.— 
‘‘(A) IN
GENERAL.—In the case of any 
taxable year beginning after 2016, the dollar 
amounts under the third sentence of subsection 
(a) shall be increased by an amount equal to— 
‘‘(i) such dollar amount, multiplied by 
‘‘(ii) the cost-of-living adjustment de-
termined under section 1(f)(3) for the cal-
endar year in which the taxable year be-
gins, determined by substituting ‘2015’ for 
‘1992’ in subparagraph (B) thereof. 
‘‘(B) ROUNDING.—If any amount as ad-
justed under subparagraph (A) is not a multiple 
of $100, such amount shall be rounded to the 
nearest multiple of $100.’’. 
(2) CONTRIBUTIONS PRE-TAX.—Subsection (a) 
of section 3401 of such Code is amended by adding 
at the end the following new sentence: ‘‘Such term 
shall not include so much of any amounts deducted 
and withheld from such remuneration under section 
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121 
3101(d) for any taxable year as does not exceed 
$2,500 ($5,000 in the case of a married couple filing 
jointly).’’. 
(b) SELF-EMPLOYMENT.— 
(1) IN GENERAL.—Section 1401 of such Code 
is amended by adding at the end the following new 
subsection: 
‘‘(d) 
HEALTH
INDIVIDUAL
RETIREMENT
AC-
COUNTS.— 
‘‘(1) IN GENERAL.—In addition to the taxes im-
posed by the preceding subsections, in the case of an 
individual with self-employment income for the tax-
able year, such individual shall contribute for such 
taxable year an amount equal to the applicable per-
centage of such self employment income. 
‘‘(2) APPLICABLE PERCENTAGE.—For purposes 
of this subsection, the applicable percentage shall be 
2 percent, or such other percentage (including zero) 
as the individual elects, in such form and manner as 
the Secretary shall prescribe. 
‘‘(3) INFLATION ADJUSTMENT.— 
‘‘(A) IN
GENERAL.—In the case of any 
taxable year beginning after 2016, the dollar 
amounts under subsection (a)(18) shall be in-
creased by an amount equal to— 
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122 
‘‘(i) such dollar amount, multiplied by 
‘‘(ii) the cost-of-living adjustment de-
termined under section 1(f)(3) for the cal-
endar year in which the taxable year be-
gins, determined by substituting ‘2015’ for 
‘1992’ in subparagraph (B) thereof. 
‘‘(B) ROUNDING.—If any amount as ad-
justed under subparagraph (A) is not a multiple 
of $100, such amount shall be rounded to the 
nearest multiple of $100.’’. 
(2) 
DEDUCTION
FOR
SELF-EMPLOYMENT 
AMOUNTS CONTRIBUTED TO HIRA.—Subsection (a) 
of section 1401 of such Code is amended by striking 
‘‘and’’ at the end of paragraph (16), but striking the 
period at the end of paragraph (17) and inserting ‘‘; 
and’’, and by inserting after paragraph (17) the fol-
lowing new paragraph: 
‘‘(18) there shall be excluded so much of any 
amounts contributed by the individual for such tax-
able year under 1401(d) as does not exceed $2,500 
($5,000 in the case of a married couple filing joint-
ly) reduced (but not below zero) by the amount of 
contributions for the taxable year with respect to the 
individual under section 3101.’’. 
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123 
(c) PROCEDURE FOR RECONCILIATION.—The Sec-
retary of the Treasury shall, in consultation with the Com-
mission of Social Security, prescribe such regulations and 
guidance as are necessary to— 
(1) allow the taxpayer to make additional con-
tributions in any case in which contributions for the 
taxable year are less than the applicable limitations 
for the taxable year under sections 3101(d) and 
1401(d) with respect to the taxpayer, and 
(2) provide for adding to gross income of the 
taxpayer for the taxable year amounts equal to any 
contributions in excess of such applicable limitations. 
(d) ELECTION COORDINATION.—The Secretary of 
the Treasury and the Commissioner of Social Security 
shall consult and cooperate in prescribing the time, form, 
and manner of elections under sections 3101(d) and 
1401(d) of the Internal Revenue Code of 1986 and section 
203(a) this Act so as to reduce unnecessary paperwork 
and duplication. 
SEC. 213. CONTRIBUTIONS ELIGIBLE FOR SAVER’S CREDIT. 
(a) IN GENERAL.—Paragraph (1) of section 25B(d) 
of the Internal Revenue Code of 1986 is amended by strik-
ing ‘‘and’’ at the end of subparagraph (B), by striking 
the period at the end of subparagraph (C) and inserting 
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124 
‘‘, and’’, and by adding at the end the following new sub-
paragraph: 
‘‘(D) the amount of contributions with re-
spect to the individual pursuant to sections 
3101(d) and 1401(d) (reduced or increased, as 
the case may be, to account for any reconcili-
ation under section 212(d) of the Save and 
Strengthen Medicare Act of 2012).’’. 
(b) PORTION OF CREDIT MADE REFUNDABLE.—Sec-
tion 25B of such Code is amended by adding at the end 
the following new subsection: 
‘‘(h) PORTION OF CREDIT REFUNDABLE.— 
‘‘(1) IN GENERAL.—The aggregate credits al-
lowed to a taxpayer under subpart C shall be in-
creased by the lesser of— 
‘‘(A) the credit which would be allowed 
under this section without regard to this sub-
section and the limitation under section 
26(a)(2) or subsection (g), as the case may be, 
or 
‘‘(B) the amount by which the aggregate 
amount of credits allowed by this subpart (de-
termined without regard to this subsection) 
would be increased if the limitation imposed by 
section 26(a)(2) or subsection (g), as the case 
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126 
to employment during the calendar year in 
which the taxable year begins, 
‘‘(iii) the amount of the taxes imposed 
by section 1401(b) on the self-employment 
income of the taxpayer for the taxable 
year, and 
‘‘(iv) the amount of the taxes imposed 
by section 3211(a) (to the extent attrib-
utable to the rate in effect under sections 
3101(b) and 3111(b)) on amounts received 
by the taxpayer during the calendar year 
in which the taxable year begins. 
‘‘(B) COORDINATION
WITH
SPECIAL
RE-
FUND OF TAX.—The term ‘hospital insurance 
taxes’ shall not include any taxes to the extent 
the taxpayer is entitled to a special refund of 
such taxes under section 6413(c). 
‘‘(C) SPECIAL RULE.—Any amounts paid 
pursuant to an agreement under section 3121(l) 
(relating to agreements entered into by Amer-
ican employers with respect to foreign affiliates) 
which are equivalent to the taxes referred to in 
subparagraph (A)(i) shall be treated as taxes 
referred to in such subparagraph.’’. 
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127 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to taxable years beginning after 
December 31, 2015. 
SEC. 214. EXCLUSION OF CERTAIN HIRA TRANSFERS. 
(a) IN GENERAL.—Part II of subchapter B of chap-
ter 1 of the Internal Revenue Code of 1986 is amended 
by inserting before section 140 the following new section: 
‘‘SEC. 139F. GOVERNMENT HIRA SUBSIDIES. 
‘‘Gross income shall not include any payment to the 
health individual retirement account (as defined in section 
530A(d)(3)) of an individual by the Secretary of Health 
and Human Services under part E of title XVIII of the 
Social Security Act.’’. 
Subtitle C—Other Tax Provisions 
SEC. 221. HEALTH SAVINGS ACCOUNTS AVAILABLE TO INDI-
VIDUALS ELIGIBLE FOR MEDICARE. 
(a) IN GENERAL.—Subsection (b) of section 223 of 
the Internal Revenue Code of 1986 is amended by striking 
paragraph (7) and by redesignating paragraph (8) as 
paragraph (7). 
(b) ELIMINATION OF MEDICARE ELIGIBILITY EX-
CEPTION TO NONQUALIFIED WITHDRAWAL PENALTY.— 
Paragraph (4) of section 223(f) of such Code is amended 
by striking subparagraph (C). 
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128 
(c) CONFORMING AMENDMENT.—Subparagraph (S) 
of section 26(b)(2) of such Code is amended by striking 
‘‘223(b)(8)(B)(i)(II)’’ 
and 
inserting 
‘‘223(b)(7)(B)(i)(II)’’. 
(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply to taxable years beginning after 
December 31, 2015. 
SEC. 222. REDUCTION IN MEDICARE PORTION OF PAYROLL 
TAX TO INCENTIVIZE LATE RETIREMENT. 
(a) EMPLOYEES.—Section 3101 of the Internal Rev-
enue Code of 1986, as amended by this Act, is amended 
by adding at the end the following new subsection: 
‘‘(e) 
EXCEPTION
FOR
INDIVIDUALS
AND 
OLDER.— 
‘‘(1) IN GENERAL.—In the case of an individual 
who has attained the age of 65, the rate of tax oth-
erwise in effect under subsection (b)— 
‘‘(A) shall be 1⁄2 such rate, if such indi-
vidual has not attained the applicable age, and 
‘‘(B) shall be zero, if such individual has 
attainted the applicable age. 
‘‘(2) APPLICABLE AGE.—For purposes of this 
subsection— 
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129 
‘‘(A) IN GENERAL.—Except as provided in 
subparagraph (B), the applicable age shall be 
67. 
‘‘(B) PREFERRED MEDICARE AGE.—In the 
case of wages received after December 31, 
2025, the applicable age shall be the preferred 
Medicare age (within the meaning of section 
216(m)(2)(B) of the Social Security Act).’’. 
(b) EMPLOYERS.—Section 3111 of such Code is 
amended by adding at the end the following new sub-
section: 
‘‘(d) 
EXCEPTION
FOR
INDIVIDUALS
AND 
OLDER.—In the case of an individual who has attained 
the age of 65, the rate of tax otherwise in effect under 
subsection (b)— 
‘‘(1) shall be 1⁄2 such rate, if such individual 
has not attained the applicable age (within the 
meaning of section 3101(e)(2)), and 
‘‘(2) shall be zero, if such individual has at-
tained such age.’’. 
(c) SELF-EMPLOYMENT.—Section 1401 of such 
Code, as amended by this Act, is amended by adding at 
the end the following new subsection: 
‘‘(e) 
EXCEPTION
FOR
INDIVIDUALS
AND 
OLDER.— 
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130 
‘‘(1) IN GENERAL.—In the case of an individual 
who has attained the age of 65, the rate of tax oth-
erwise in effect under subsection (b) for the taxable 
year— 
‘‘(A) shall be 1⁄2 such rate, if such indi-
vidual has not attained the applicable age be-
fore the end of such taxable year, and 
‘‘(B) shall be zero, if such individual has 
attained such age before the end of such tax-
able year. 
‘‘(2) APPLICABLE AGE.—For purposes of this 
subsection— 
‘‘(A) IN GENERAL.—Except as provided in 
subparagraph (B), the applicable age shall be 
67. 
‘‘(B) PREFERRED MEDICARE AGE.—In the 
case of taxable years beginning after December 
31, 2025, the applicable age shall be the pre-
ferred Medicare age (within the meaning of sec-
tion 216(m)(2)(B) of the Social Security Act).’’. 
(d) EFFECTIVE DATES.— 
(1) SUBSECTIONS (a) AND (b).—The amend-
ments made by subsections (a) and (b) shall apply 
to wages paid after December 31, 2015. 
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131 
(2) SUBSECTION (c).—The amendments made 
by subsection (c) shall apply to remuneration paid in 
taxable years ending after December 31, 2015. 
SEC. 223. 15-PERCENT EXCISE TAX ON EMPLOYER-SPON-
SORED 
MEDICARE 
SUPPLEMENTAL 
COV-
ERAGE. 
(a) IN GENERAL.—Chapter 43 of the Internal Rev-
enue Code of 1986 is amended by adding at the end the 
following new section: 
‘‘SEC. 4980J. EMPLOYER-SPONSORED MEDICARE SUPPLE-
MENTAL COVERAGE. 
‘‘(a) IMPOSITION OF TAX.—In the case of any em-
ployee who— 
‘‘(1) becomes a Medicare enrollee (as defined in 
section 1860E–61(b) of the Social Security Act) 
after December 31, 2015, and 
‘‘(2) is covered for any period during a calendar 
year beginning after such date under applicable em-
ployer-sponsored supplemental coverage, 
there is hereby imposed a tax equal to 15 percent of the 
aggregate cost (determined under rules similar to the rules 
of section 4980B(f)(4)) of such coverage of the employee 
for such period. 
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‘‘(b) LIABILITY TO PAY TAX.—The coverage provider 
(as defined in section 4980I(c)(1)) shall pay the tax im-
posed by subsection (a). 
‘‘(c) APPLICABLE EMPLOYER-SPONSORED SUPPLE-
MENTAL COVERAGE.—For purposes of this section— 
‘‘(1) IN GENERAL.—The term ‘applicable em-
ployer-sponsored supplemental coverage’ means, with 
respect to any employee, any first-dollar coverage 
made available by an employer to an employee dur-
ing the calendar year. 
‘‘(2) FIRST-DOLLAR INSURANCE COVERAGE.— 
The term ‘first-dollar insurance coverage’ means 
coverage for— 
‘‘(A) the amount of the unified deductible 
for the calendar year under section 1860E– 
21(b) of the Social Security Act, and 
‘‘(B) the first $500 of coinsurance for the 
calendar year under section 1860E–22 of such 
Act. 
‘‘(3) COVERAGE
INCLUDES
EMPLOYEE
PAID 
PORTION.—Coverage shall be treated as applicable 
employer-sponsored supplemental coverage without 
regard to whether the employer or employee pays for 
the coverage. 
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‘‘(4) SELF-EMPLOYED
INDIVIDUAL.—In the 
case of an individual who is an employee within the 
meaning of section 401(c)(1), coverage under any 
group health plan providing health insurance cov-
erage shall be treated as applicable employer-spon-
sored coverage if a deduction is allowable under sec-
tion 162(l) with respect to all or any portion of the 
cost of the coverage. 
‘‘(5) EMPLOYEE.—The term ‘employee’ includes 
any former employee, surviving spouse, or other pri-
mary insured adult. 
‘‘(6) GOVERNMENTAL PLANS INCLUDED.—Ap-
plicable employer-sponsored coverage shall include 
coverage under any group health plan established 
and maintained primarily for its civilian employees 
by the Government of the United States, by the gov-
ernment of any State or political subdivision thereof, 
or by any agency or instrumentality of any such gov-
ernment. 
‘‘(7) 
NOT
APPLICABLE
TO
CERTAIN
AC-
COUNTS.—The term ‘first-dollar coverage’ does not 
include coverage under a flexible spending arrange-
ment (as defined in section 106(c)(2)), coverage 
under an arrangement under which the employer 
makes contributions described in subsection (b) or 
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(d) of section 106, a health reimbursement arrange-
ment treated as employer coverage under an acci-
dent or health plan for purposes of section 106, or 
coverage under a health individual retirement ac-
count (as defined in section 530A(d)(3)). 
‘‘(8) DENIAL OF DEDUCTION.—For denial of 
deduction for the tax imposed by this section, see 
section 275(a)(6). 
‘‘(d) REGULATIONS.—The Secretary shall prescribe 
such regulations as may be necessary to carry out this 
section.’’. 
(b) CLERICAL AMENDMENT.—The table of sections 
for chapter 43 of such Code is amended by adding at the 
end the following new item: 
‘‘Sec. 4980J. Employer-sponsored Medicare supplemental coverage.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to periods after December 31, 
2015. 
TITLE III—OTHER HEALTH 
PROVISIONS 
Subtitle A—Transparency, 
Outreach, and Education 
SEC. 301. PUBLIC OUTREACH AND EDUCATION INITIA-
TIVES. 
Beginning not later than January 1, 2015, the Medi-
care Choices Commission shall conduct public outreach 
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and education efforts, through a variety of media and fo-
rums, to provide information to Medicare enrollees (as de-
fined in section 1860E–51 of the Social Security Act), 
providers of services and suppliers (as such terms are de-
fined in section 1861 of such Act), health insurance plans, 
and other appropriate individuals and entities on the 
modifications made by the provisions of, including amend-
ments made by, this Act to Medicare under title XVIII 
of the Social Security Act. Such efforts shall include at 
least the following: 
(1) Interactive Web sites for Medicare enrollees. 
(2) Opportunities for Medicare enrollees to sign 
up for informational emails from the Centers of 
Medicare & Medicaid Services. 
(3) Social media pages to provide basic facts to 
Medicare enrollees and family members of such en-
rollees. 
(4) National town hall meetings. 
(5) Educational materials for hospitals, medical 
schools, and other providers of services and sup-
pliers. 
(6) Resources for physicians, home nurses, and 
other medical professionals to provide to patients. 
(7) Coordination with a broad range of commu-
nity partners, including community centers, retire-
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ment centers, assisted living communities, and faith- 
based organizations. 
(8) Coordination with health plans. 
SEC. 302. ANNUAL MEDICARE BENEFICIARY CONTRIBU-
TIONS AND BENEFITS STATEMENTS. 
(a) IN GENERAL.—Part A of title XI of the Social 
Security Act is amended by inserting after section 1143 
(42 U.S.C. 1320b–13) the following new section: 
‘‘SEC. 1143A. ANNUAL MEDICARE BENEFICIARY CONTRIBU-
TIONS AND BENEFITS STATEMENTS. 
‘‘(a) PROVISION.— 
‘‘(1) IN GENERAL.—Beginning not later than 2 
years after the date of the enactment of this section, 
the Medicare Choices Commission established under 
section 1860E–51, in coordination with the Commis-
sioner of Social Security, shall provide a statement 
described in subsection (b) (in this section referred 
to as an ‘annual Medicare information statement’) 
on an annual basis to each eligible individual (as de-
fined in subsection (d)) for whom a current mailing 
address can be determined through such methods as 
the Medicare Choices Commission determines to be 
appropriate. 
‘‘(2) COORDINATION IN SINGLE MAILING WITH 
SOCIAL SECURITY ACCOUNT STATEMENTS.—In order 
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