I 
115TH CONGRESS 
1ST SESSION H. R. 3748 
To amend title XVIII of the Social Security Act to provide for an option 
for individuals who are ages 50 to 64 to buy into Medicare, to provide 
for health insurance market stabilization, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 12, 2017 
Mr. HIGGINS of New York (for himself, Mr. LARSON of Connecticut, Mr. 
COURTNEY, Mr. CARSON of Indiana, Mr. CICILLINE, Mr. COHEN, Ms. 
DELAURO, Mr. DEUTCH, Mr. HUFFMAN, Ms. KAPTUR, Mr. KEATING, 
Mr. KHANNA, Mr. KRISHNAMOORTHI, Ms. MCCOLLUM, Mr. MCEACHIN, 
Mr. MCGOVERN, Mr. PERLMUTTER, Mr. PRICE of North Carolina, Mr. 
QUIGLEY, Mr. RYAN of Ohio, Ms. TITUS, Mr. TONKO, Mr. WELCH, Mr. 
DELANEY, Ms. PINGREE, Ms. ESTY of Connecticut, Mr. LOWENTHAL, 
Mr. KIHUEN, Mrs. NAPOLITANO, Mr. SEAN PATRICK MALONEY of New 
York, Mr. GARAMENDI, Ms. SHEA-PORTER, Mr. PETERSON, Mr. POLIS, 
and Mr. HECK) introduced the following bill; which was referred to the 
Committee on Energy and Commerce, and in addition to the Committee 
on Ways and Means, for a period to be subsequently determined by the 
Speaker, in each case for consideration of such provisions as fall within 
the jurisdiction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to provide 
for an option for individuals who are ages 50 to 64 
to buy into Medicare, to provide for health insurance 
market stabilization, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Medicare Buy-In and 
Health Care Stabilization Act of 2017’’. 
SEC. 2. MEDICARE BUY-IN OPTION. 
(a) IN GENERAL.—Title XVIII of the Social Security 
Act (42 U.S.C. 1395c et seq.) is amended by adding at 
the end the following new section: 
‘‘MEDICARE BUY-IN OPTION 
‘‘SEC. 1899C. (a) OPTION.— 
‘‘(1) ELIGIBILITY.—Every individual who meets 
the requirements described in paragraph (3) shall be 
eligible to enroll under this section. 
‘‘(2) IN GENERAL.—An individual who meets 
the following requirements is eligible to enroll under 
this section: 
‘‘(A) AGE.—The individual has attained 50 
years of age, but has not attained 65 years of 
age. 
‘‘(B) MEDICARE
ELIGIBILITY
(BUT
FOR 
AGE).—The individual is not otherwise entitled 
to benefits under part A or eligible to enroll 
under part A or part B but would be eligible for 
benefits under part A or part B if the indi-
vidual were 65 years of age. 
‘‘(3) BENEFITS.—An individual enrolled under 
this section is entitled to the same benefits under 
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this title as an individual who is entitled to benefits 
under part A and enrolled under parts B and D. 
‘‘(b) ENROLLMENT AND COVERAGE PERIODS.—The 
Secretary shall establish enrollment and coverage periods 
for individuals who enroll under this section. Such periods 
shall be established in coordination with the enrollment 
and coverage periods for plans offered under an Exchange 
established under title I of the Patient Protection and Af-
fordable Care Act. The Secretary shall establish such peri-
ods so that coverage under this section shall first begin 
on January 1 of the first year beginning at least one year 
after the date of the enactment of this section. 
‘‘(c) BUY-IN PREMIUM.— 
‘‘(1) AMOUNT OF MONTHLY PREMIUMS.—The 
Secretary shall (beginning for the first year that be-
gins more than 1 year after the date of the enact-
ment of this section), during September of the pre-
ceding year, determine a monthly premium for indi-
viduals enrolled under this section. Such monthly 
premium shall be equal to 1⁄12 of the annual pre-
mium computed under paragraph (2)(B), which 
shall apply with respect to coverage provided under 
this section for any month in such year. 
‘‘(2) ANNUAL PREMIUM.— 
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‘‘(A) COMBINED
NATIONAL, PER
CAPITA 
AVERAGE FOR PARTS A, B, AND D BENEFITS.— 
The Secretary shall estimate the average, an-
nual per capita amount for benefits and admin-
istrative expenses that will be payable under 
parts A, B, and D in the year for all individuals 
enrolled under this section. 
‘‘(B) ANNUAL PREMIUM.—The annual pre-
mium under this subsection for months in a 
year is equal to the average, annual per capita 
amount estimated under subparagraph (A) for 
the year. 
‘‘(C) ADJUSTMENTS.—The Secretary shall 
adjust the annual premium under this sub-
section as necessary— 
‘‘(i) to ensure that expenditures under 
this title for any year are not increased by 
reason of this section; and 
‘‘(ii) by a geographic adjustment fac-
tor to address regional affordability con-
cerns. 
‘‘(3) ADDITIONAL
PREMIUM
FOR
CERTAIN
D 
PLANS.—Nothing in this section shall preclude an 
individual from choosing a prescription drug plan 
which requires the individual to pay an additional 
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amount (because of the inclusion of supplemental 
prescription drug benefits or because the plan is a 
more expensive plan, pursuant to section 1860D– 
13(a)(1)). In such case, the monthly premium under 
paragraph (1) shall be increased with respect to 
such individual. 
‘‘(d) PAYMENT OF PREMIUMS.— 
‘‘(1) PAYMENT.— 
‘‘(A) IN GENERAL.—Premiums for enroll-
ment under this section shall be paid to the 
Secretary at such times, and in such manner, 
as the Secretary determines appropriate. 
‘‘(B) PAYMENT OF PREMIUMS BY EMPLOY-
ERS ON BEHALF OF EMPLOYEES.—An employer 
of an individual who enrolls under this section 
may make payments for the premiums for such 
enrollment on behalf of such individual pursu-
ant to a process established by the Secretary. 
Such process shall ensure that enrollment under 
this section is the choice of the individual and 
not the employer. 
‘‘(2) DEPOSIT.—Amounts collected by the Sec-
retary under this section shall be deposited in the 
Medicare Buy-In Trust Fund established under sub-
section (e). 
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‘‘(e) MEDICARE BUY-IN TRUST FUND.— 
‘‘(1) IN GENERAL.—There is hereby created on 
the books of the Treasury of the United States a 
trust fund to be known as the ‘Medicare Buy-In 
Trust Fund’ (in this subsection referred to as the 
‘Trust Fund’). The Trust Fund shall consist of such 
gifts and bequests as may be made as provided in 
section 201(i)(1) and such amounts as may be de-
posited in, or appropriated to, such fund as provided 
in this title. 
‘‘(2) PREMIUMS.—Premiums collected under 
subsection (d) shall be transferred to the Trust 
Fund. 
‘‘(3) INCORPORATION
OF
PROVISIONS.—Sub-
sections (b) through (i) of section 1841 shall apply 
with respect to the Trust Fund and this title in the 
same manner as they apply with respect to the Fed-
eral Supplementary Medical Insurance Trust Fund 
and part B, respectively, except that in applying 
such section 1841, any reference in such section to 
‘this part’ shall be construed to be a reference to 
this section and any reference in section 1841(h) to 
section 1840(d) and in section 1841(i) to sections 
1840(b)(1) and 1842(g) are deemed to be references 
to comparable authority exercised under this section. 
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‘‘(f) CLARIFICATION.—Nothing in this section shall 
affect the benefits or eligibility under this title of individ-
uals who would otherwise be entitled to or eligible for ben-
efits under this title or title XIX, or both. 
‘‘(g) TREATMENT IN RELATION TO THE AFFORD-
ABLE CARE ACT.— 
‘‘(1) SATISFACTION
OF
INDIVIDUAL
MAN-
DATE.—For purposes of applying section 5000A of 
the Internal Revenue Code of 1986, the coverage 
provided through enrollment under this section con-
stitutes minimum essential coverage under sub-
section (f)(1)(A)(i) of such section. 
‘‘(2) ELIGIBILITY FOR PREMIUM ASSISTANCE.— 
Coverage provided through enrollment under this 
section— 
‘‘(A) shall be treated as coverage under a 
qualified health plan in the individual market 
enrolled in through the Exchange where the in-
dividual resides for all purposes of section 36B 
of the Internal Revenue Code of 1986 other 
than subsection (c)(2)(B) thereof; and 
‘‘(B) shall not be treated as eligibility for 
other minimum essential coverage for purposes 
of subsection (c)(2)(B) of such section 36B. 
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