I 
116TH CONGRESS 
1ST SESSION H. R. 1346 
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 
FEBRUARY 25, 2019 
Mr. HIGGINS of New York (for himself, Mr. LARSON of Connecticut, Mr. 
COURTNEY, Mr. WELCH, Mr. AGUILAR, Ms. BONAMICI, Mr. BRENDAN F. 
BOYLE of Pennsylvania, Mr. CLAY, Mr. DEUTCH, Mr. MICHAEL F. 
DOYLE of Pennsylvania, Mr. HECK, Mr. KRISHNAMOORTHI, Ms. KUSTER 
of New Hampshire, Mr. LANGEVIN, Mr. LARSEN of Washington, Mr. 
LOWENTHAL, Mr. SEAN PATRICK MALONEY of New York, Mr. MEEKS, 
Ms. NORTON, Mr. PERLMUTTER, Mr. PETERSON, Mr. SCHIFF, Ms. 
TITUS, Mr. TONKO, Ms. WASSERMAN SCHULTZ, Ms. WILD, and Mr. 
MCGOVERN) introduced the following bill; which was referred to the Com-
mittee 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 2019’’. 
SEC. 2. FINDINGS. 
Congress finds as follows: 
(1) Medicare has coverage gaps and should pro-
vide more comprehensive coverage, including increas-
ing coverage for the medical needs of beneficiaries 
relating to hearing, dental, and vision care. 
(2) Special needs populations face financial 
challenges to secure coverage for Medicare’s out of 
pocket costs and other hurdles. 
(3) Medicare Buy-In is a step in the right di-
rection as Congress considers additional needed leg-
islation to address these and other coverage issues 
and beneficiary financial challenges in Medicare and 
Medicare Buy-In. 
SEC. 3. 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) IN GENERAL.—Every individual who meets 
the requirements described in paragraph (2) shall be 
eligible to enroll under this section. 
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‘‘(2) ELIGIBILITY.—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) PART A, B, AND D BENEFITS AND PROTEC-
TIONS.—An individual enrolled under this section is 
entitled to the same benefits (and shall receive the 
same protections) under this title as an individual 
who is entitled to benefits under part A and enrolled 
under parts B and D, including the ability to enroll 
in a Medicare Advantage plan that provides qualified 
prescription drug coverage (an MA–PD plan) and 
including access to the Medicare Beneficiary Om-
budsman under section 1808(c). 
‘‘(b) ENROLLMENT AND COVERAGE PERIODS.—The 
Secretary shall establish enrollment and coverage periods 
for individuals who enroll under this section. Such periods 
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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 and shall 
include special enrollment periods, in accordance with sec-
tion 155.420 of title 45 of the Code of Federal Regula-
tions, that are applicable to qualified health plans offered 
through an Exchange. 
‘‘(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.— 
‘‘(A) COMBINED
NATIONAL, PER
CAPITA 
AVERAGE FOR PARTS A, B, AND D BENEFITS.— 
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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.—Subject to sub-
paragraphs (C) and (D), the annual premium 
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. 
‘‘(D) 
AUTHORITY
TO
CALCULATE 
AMOUNTS OF MONTHLY PREMIUMS SEPARATELY 
FOR DIFFERENT AGES.—In determining the an-
nual premium amount under this paragraph for 
months in a year, the Secretary may make sep-
arate determinations of such amount for indi-
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viduals by age, if the Secretary determines that 
making such separate determinations would in-
crease enrollment under this section and reduce 
the risk of adverse selection. 
‘‘(3) ADDITIONAL PREMIUM FOR CERTAIN PART 
D PLANS.—Nothing in this section shall preclude an 
individual from choosing a prescription drug plan 
which requires the individual to pay an additional 
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.—Premiums 
for 
enrollment 
under this section shall be paid to the Secretary at 
such times, and in such manner, as the Secretary 
determines appropriate. 
‘‘(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). 
‘‘(e) MEDICARE BUY-IN TRUST FUND.— 
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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). 
‘‘(4) ACCESS TO MEDIGAP.—Coverage provided 
through medicare supplemental policies certified 
under section 1882 shall be made available to indi-
viduals eligible for enrollment pursuant to this sec-
tion for enrollment, information, comparison, and 
otherwise as such a policy through any internet 
website described in paragraph (2). 
‘‘(i) 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 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. 
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‘‘(j) OUTREACH AND ENROLLMENT.— 
‘‘(1) IN GENERAL.—During the period that be-
gins on January 1, 2019, and ends on December 31, 
2021, the Secretary shall award grants to eligible 
entities for the following purposes: 
‘‘(A) OUTREACH AND ENROLLMENT.—To 
carry out outreach, public education activities, 
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.— 
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‘‘(A) IN GENERAL.—In this subsection, the 
term ‘eligible entity’ means— 
‘‘(i) a State; or 
‘‘(ii) a nonprofit community-based or-
ganization. 
‘‘(B) ENROLLMENT AGENTS.—Such term 
includes a licensed independent insurance agent 
or broker that has an arrangement with a State 
or nonprofit community-based organization to 
enroll 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. 
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‘‘(4) FUNDING.—Out of any moneys in the 
Treasury not otherwise appropriated, $500,000,000 
is appropriated to the Secretary for each of calendar 
years 2019 through 2021, to carry out this sub-
section. 
‘‘(k) IMPLEMENTATION.— 
‘‘(1) CONSULTATION.—In carrying out this sec-
tion, the Secretary shall— 
‘‘(A) consult with other Federal agencies, 
including the Department of the Treasury, the 
Department of Labor, the Department of Vet-
erans Affairs, the Department of Defense, and 
the Office of Personnel Management; and 
‘‘(B) incorporate significant public con-
sultation and feedback, through public forums, 
notice and comment rulemaking, and any other 
appropriate mediums. 
‘‘(2) REPORT.—No later than one year after 
the date of the enactment of this section, the Sec-
retary shall submit to Congress a report establishing 
the administrative parameters for the implementa-
tion of this section. 
‘‘(l) FEASIBILITY STUDY.—The Secretary shall con-
duct a study on the feasibility of applying this section with 
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respect to individuals residing in States that are not with-
in the 50 States or the District of Columbia.’’. 
(b) MEDIGAP.—Section 1882 of the Social Security 
Act is amended by adding at the end the following new 
subsection: 
‘‘(aa) DEVELOPMENT OF NEW STANDARDS FOR CER-
TAIN MEDICARE SUPPLEMENTAL POLICIES RELATING TO 
BUY-IN OPTION.—The Secretary shall request the Na-
tional Association of Insurance Commissioners to review 
and revise the standards for benefit packages described 
in subsection (p)(1), to otherwise update standards to in-
clude requirements for each medicare supplemental policy 
that offers such a policy in a State, with respect to each 
year, to accept every individual in the State who is eligible 
for enrollment pursuant to section 1899C and who applies 
for such coverage for such year if the individual applies 
for enrollment in such policy during the 30-day period fol-
lowing the date of enrollment pursuant to section 1899C 
and to accept every such individual during a period of 
transition from enrollment pursuant to such section to en-
rollment under this title pursuant to eligibility other than 
under such section. Such revisions shall be made con-
sistent with the rules applicable under subsection 
(p)(1)(E) with the reference to the ‘1991 NAIC Model 
Regulation’ deemed a reference to the NAIC Model Regu-
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