ing given the term ‘COBRA continuation provi-
sion’ in section 2791(d)(4) of the Public Health
Service Act and includes a comparable State
program, as determined by the Secretary.
‘‘(B) FEDERAL HEALTH INSURANCE PRO-
GRAM DEFINED.—The term ‘Federal health in-
surance program’ means any of the following:
‘‘(i) MEDICARE.—Part A or part B of
this title (other than by reason of this
part).
‘‘(ii) MEDICAID.—A State plan under
title XIX.
‘‘(iii) FEHBP.—The Federal employ-
ees health benefit program under chapter
89 of title 5, United States Code.
‘‘(iv) 
TRICARE.—The 
TRICARE
program (as defined in section 1072(7) of
title 10, United States Code).
‘‘(v) ACTIVE DUTY MILITARY.—Health
benefits under title 10, United States
Code, to an individual as a member of the
uniformed services of the United States.
‘‘(C) GROUP
HEALTH
PLAN.—The term
‘group health plan’ has the meaning given such
term in section 2791(a)(1) of the Public Health
Service Act.
‘‘(b) ELIGIBILITY OF INDIVIDUALS AGE 62-TO-65
YEARS OF AGE.—
‘‘(1) IN GENERAL.—Subject to paragraph (2),
an individual who meets the following requirements
with respect to a month is eligible to enroll under
this part with respect to such month:
‘‘(A) AGE.—As of the last day of the
month, the individual has attained 62 years of
age, but has not attained 65 years of age.
‘‘(B) MEDICARE
ELIGIBILITY
(BUT
FOR
AGE).—The individual would be eligible for ben-
efits under part A or part B for the month if
the individual were 65 years of age.
‘‘(C) 
NOT
ELIGIBLE
FOR
COVERAGE
UNDER
GROUP
HEALTH
PLANS
OR
FEDERAL
HEALTH
INSURANCE
PROGRAMS.—The indi-
vidual is not eligible for benefits or coverage
under a Federal health insurance program (as
defined in subsection (a)(2)(B)) or under a
group health plan (other than such eligibility
merely through a Federal or State COBRA con-
tinuation provision) as of the last day of the
month involved.
‘‘(2) LIMITATION
ON
ELIGIBILITY
IF
TERMI-
NATED ENROLLMENT.—If an individual described in
paragraph (1) enrolls under this part and coverage
of the individual is terminated under section
1859A(d) (other than because of age), the individual
is not again eligible to enroll under this subsection
unless the following requirements are met:
‘‘(A) NEW
COVERAGE
UNDER
GROUP
HEALTH
PLAN
OR
FEDERAL
HEALTH
INSUR-
ANCE PROGRAM.—After the date of termination
of coverage under such section, the individual
obtains coverage under a group health plan or
under a Federal health insurance program.
‘‘(B) SUBSEQUENT
LOSS
OF
NEW
COV-
ERAGE.—The individual subsequently loses eli-
gibility for the coverage described in subpara-
graph (A) and exhausts any eligibility the indi-
vidual may subsequently have for coverage
under a Federal or State COBRA continuation
provision.
‘‘(3) CHANGE
IN
HEALTH
PLAN
ELIGIBILITY
DOES NOT AFFECT COVERAGE.—In the case of an
individual who is eligible for and enrolls under this
part under this subsection, the individual’s continued
entitlement to benefits under this part shall not be
affected by the individual’s subsequent eligibility for
benefits or coverage described in paragraph (1)(C),
or entitlement to such benefits or coverage.
‘‘SEC. 1859A. ENROLLMENT PROCESS; COVERAGE.
‘‘(a) IN GENERAL.—An individual may enroll in the
program established under this part only in such manner
and form as may be prescribed by regulations, and only
during an enrollment period prescribed by the Secretary
consistent with the provisions of this section. Such regula-
tions shall provide a process under which—
‘‘(1) individuals eligible to enroll as of a month
are permitted to pre-enroll during a prior month
within an enrollment period described in subsection
(b); and
‘‘(2) each individual seeking to enroll under sec-
tion 1859(b) is notified, before enrolling, of the de-
ferred monthly premium amount the individual will
be liable for under section 1859C(b) upon attaining
65 years of age as determined under section
1859B(c)(3).
‘‘(b) ENROLLMENT PERIODS.—
‘‘(1) INDIVIDUALS 62-TO-65 YEARS OF AGE.—In
the case of individuals eligible to enroll under this
part under section 1859(b)—
‘‘(A) INITIAL
ENROLLMENT
PERIOD.—If
the individual is eligible to enroll under such
section for July 2001, the enrollment period
shall begin on May 1, 2001, and shall end on
August 31, 2001. Any such enrollment before
July 1, 2001, is conditioned upon compliance
with the conditions of eligibility for July 2001.
‘‘(B) SUBSEQUENT PERIODS.—If the indi-
vidual is eligible to enroll under such section for
a month after July 2001, the enrollment period
shall begin on the first day of the second month
before the month in which the individual first is
eligible to so enroll and shall end four months
later. Any such enrollment before the first day
of the third month of such enrollment period is
conditioned upon compliance with the condi-
tions of eligibility for such third month.
‘‘(2) AUTHORITY
TO
CORRECT
FOR
GOVERN-
MENT ERRORS.—The provisions of section 1837(h)
apply with respect to enrollment under this part in
the same manner as they apply to enrollment under
part B.
‘‘(c) DATE COVERAGE BEGINS.—
‘‘(1) IN GENERAL.—The period during which
an individual is entitled to benefits under this part
shall begin as follows, but in no case earlier than
July 1, 2001:
‘‘(A) In the case of an individual who en-
rolls (including pre-enrolls) before the month in
which the individual satisfies eligibility for en-
rollment under section 1859, the first day of
such month of eligibility.
‘‘(B) In the case of an individual who en-
rolls during or after the month in which the in-
dividual first satisfies eligibility for enrollment
under such section, the first day of the fol-
lowing month.
‘‘(2) AUTHORITY
TO
PROVIDE
FOR
PARTIAL
MONTHS
OF
COVERAGE.—Under regulations, the
Secretary may, in the Secretary’s discretion, provide
for coverage periods that include portions of a
month in order to avoid lapses of coverage.
‘‘(3) LIMITATION ON PAYMENTS.—No payments
may be made under this title with respect to the ex-
penses of an individual enrolled under this part un-
less such expenses were incurred by such individual
during a period which, with respect to the individual,
is a coverage period under this section.
‘‘(d) TERMINATION OF COVERAGE.—
‘‘(1) IN
GENERAL.—An individual’s coverage
period under this part shall continue until the indi-
vidual’s enrollment has been terminated at the ear-
liest of the following:
‘‘(A) GENERAL PROVISIONS.—
‘‘(i) NOTICE.—The individual files no-
tice (in a form and manner prescribed by
the Secretary) that the individual no
longer wishes to participate in the insur-
ance program under this part.
‘‘(ii) NONPAYMENT OF PREMIUMS.—
The individual fails to make payment of
premiums required for enrollment under
this part.
‘‘(iii) MEDICARE
ELIGIBILITY.—The
individual becomes entitled to benefits
under part A or enrolled under part B
(other than by reason of this part).
‘‘(B) TERMINATION BASED ON AGE.—The
individual attains 65 years of age.
‘‘(2) EFFECTIVE DATE OF TERMINATION.—
‘‘(A) NOTICE.—The termination of a cov-
erage period under paragraph (1)(A)(i) shall
take effect at the close of the month following
for which the notice is filed.
‘‘(B) NONPAYMENT
OF
PREMIUM.—The
termination of a coverage period under para-
graph (1)(A)(ii) shall take effect on a date de-
termined under regulations, which may be de-
termined so as to provide a grace period in
which overdue premiums may be paid and cov-
erage continued. The grace period determined
under the preceding sentence shall not exceed
60 days; except that it may be extended for an
additional 30 days in any case where the Sec-
retary determines that there was good cause for
failure to pay the overdue premiums within
such 60-day period.
‘‘(C) AGE
OR
MEDICARE
ELIGIBILITY.—
The termination of a coverage period under
paragraph (1)(A)(iii) or (1)(B) shall take effect
as of the first day of the month in which the
individual attains 65 years of age or becomes
entitled to benefits under part A or enrolled for
benefits under part B (other than by reason of
this part).
‘‘SEC. 1859B. PREMIUMS.
‘‘(a) AMOUNT OF MONTHLY PREMIUMS.—
‘‘(1) BASE
MONTHLY
PREMIUMS.—The Sec-
retary shall, during September of each year (begin-
ning with 2000), determine the following premium
rates which shall apply with respect to coverage pro-
vided under this title for any month in the suc-
ceeding year:
‘‘(A) BASE MONTHLY PREMIUM FOR INDI-
VIDUALS 62 YEARS OF AGE OR OLDER.—A base
monthly premium for individuals 62 years of
age or older, equal to 1⁄12 of the base annual
premium rate computed under subsection (b)
for each premium area.
‘‘(2) DEFERRED MONTHLY PREMIUMS FOR IN-
DIVIDUALS 62 YEARS OF AGE OR OLDER.—The Sec-
retary shall, during September of each year (begin-
ning with 2000), determine under subsection (c) the
amount of deferred monthly premiums that shall
apply with respect to individuals who first obtain
coverage under this part under section 1859(b) in
the succeeding year.
‘‘(3) ESTABLISHMENT OF PREMIUM AREAS.—
For purposes of this part, the term ‘premium area’
means such an area as the Secretary shall specify to
carry out this part. The Secretary from time to time
may change the boundaries of such premium areas.
The Secretary shall seek to minimize the number of
such areas specified under this paragraph.
‘‘(b) BASE ANNUAL PREMIUM FOR INDIVIDUALS 62
YEARS OF AGE OR OLDER.—
‘‘(1) NATIONAL, PER
CAPITA
AVERAGE.—The
Secretary shall estimate the average, annual per
capita amount that would be payable under this title
with respect to individuals residing in the United
States who meet the requirement of section
1859(b)(1)(A) as if all such individuals were eligible
for (and enrolled) under this title during the entire
year (and assuming that section 1862(b)(2)(A)(i)
did not apply).
‘‘(2) GEOGRAPHIC
ADJUSTMENT.—The Sec-
retary shall adjust the amount determined under
paragraph (1) for each premium area (specified
under subsection (a)(3)) in order to take into ac-
count such factors as the Secretary deems appro-
priate and shall limit the maximum premium under
this paragraph in a premium area to assure partici-
pation in all areas throughout the United States.
‘‘(3) BASE ANNUAL PREMIUM.—The base an-
nual premium under this subsection for months in a
year for individuals 62 years of age or older residing
in a premium area is equal to the average, annual
per capita amount estimated under paragraph (1)
for the year, adjusted for such area under paragraph
(2).
‘‘(c) DEFERRED PREMIUM RATE FOR INDIVIDUALS
62 YEARS OF AGE OR OLDER.—The deferred premium
rate for individuals with a group of individuals who obtain
coverage under section 1859(b) in a year shall be com-
puted by the Secretary as follows:
‘‘(1) ESTIMATION OF NATIONAL, PER CAPITA
ANNUAL
AVERAGE
EXPENDITURES
FOR
ENROLL-
MENT GROUP.—The Secretary shall estimate the av-
erage, per capita annual amount that will be paid
under this part for individuals in such group during
the period of enrollment under section 1859(b). In
making such estimate for coverage beginning in a
year before 2003, the Secretary may base such esti-
mate on the average, per capita amount that would
be payable if the program had been in operation over
a previous period of at least 4 years.
‘‘(2) DIFFERENCE
BETWEEN
ESTIMATED
EX-
PENDITURES
AND
ESTIMATED
PREMIUMS.—Based
on the characteristics of individuals in such group,
the Secretary shall estimate during the period of
coverage of the group under this part under section
1859(b) the amount by which—
‘‘(A) the amount estimated under para-
graph (1); exceeds
‘‘(B) the average, annual per capita
amount of premiums that will be payable for
months during the year under section 1859C(a)
for individuals in such group (including pre-
miums that would be payable if there were no
terminations in enrollment under clause (i) or
(ii) of section 1859A(d)(1)(A)).
‘‘(3) ACTUARIAL COMPUTATION OF DEFERRED
MONTHLY
PREMIUM
RATES.—The Secretary shall
determine deferred monthly premium rates for indi-
viduals in such group in a manner so that—
‘‘(A) the estimated actuarial value of such
premiums payable under section 1859C(b), is
equal to
‘‘(B) the estimated actuarial present value
of the differences described in paragraph (2).
Such rate shall be computed for each individual in
the group in a manner so that the rate is based on
the number of months between the first month of
coverage based on enrollment under section 1859(b)
and the month in which the individual attains 65
years of age.
‘‘(4) DETERMINANTS OF ACTUARIAL PRESENT
VALUES.—The actuarial present values described in
paragraph (3) shall reflect—
‘‘(A) the estimated probabilities of survival
at ages 62 through 84 for individuals enrolled
during the year; and
‘‘(B) the estimated effective average inter-
est rates that would be earned on investments
held in the trust funds under this title during
the period in question.
‘‘SEC. 1859C. PAYMENT OF PREMIUMS.
‘‘(a) PAYMENT OF BASE MONTHLY PREMIUM.—
‘‘(1) IN GENERAL.—The Secretary shall provide
for payment and collection of the base monthly pre-
mium, determined under section 1859B(a)(1) for the
age (and age cohort, if applicable) of the individual
involved and the premium area in which the indi-
vidual principally resides, in the same manner as for
payment of monthly premiums under section 1840,
except that, for purposes of applying this section,
any reference in such section to the Federal Supple-
mentary Medical Insurance Trust Fund is deemed a
reference to the Trust Fund established under sec-
tion 1859D.
1859A(d)(1)(A), subject to clause (ii), the
amount of the deferred premium otherwise
established under this paragraph shall be
pro-rated to reflect the number of months
of coverage under this part under such en-
rollment compared to the maximum num-
ber of months of coverage that the indi-
vidual would have had if the enrollment
were not so terminated.
‘‘(ii) ROUNDING
TO
12-MONTH
MIN-
IMUM
COVERAGE
PERIODS.—In applying
clause (i), the number of months of cov-
erage (if not a multiple of 12) shall be
rounded to the next highest multiple of 12
months, except that in no case shall this
clause result in a number of months of
coverage exceeding the maximum number
of months of coverage that the individual
would have had if the enrollment were not
so terminated.
‘‘(2) PERIOD
OF
PAYMENT.—The period de-
scribed in this paragraph for an individual is the pe-
riod beginning with the first month in which the in-
dividual has attained 65 years of age and ending
with the month before the month in which the indi-
vidual attains 85 years of age.
‘‘(3) COLLECTION.—In the case of an individual
who is liable for a premium under this subsection,
the amount of the premium shall be collected in the
same manner as the premium for enrollment under
such part is collected under section 1840, except
that any reference in such section to the Federal
Supplementary Medical Insurance Trust Fund is
deemed to be a reference to the Medicare Early Ac-
cess Trust Fund established under section 1859D.
‘‘(c) APPLICATION OF CERTAIN PROVISIONS.—The
provisions of section 1840 (other than subsection (h))
shall apply to premiums collected under this section in the
same manner as they apply to premiums collected under
part B, except that any reference in such section to the
Federal Supplementary Medical Insurance Trust Fund is
deemed a reference to the Trust Fund established under
section 1859D.
‘‘SEC. 1859D. MEDICARE EARLY ACCESS TRUST FUND.
‘‘(a) ESTABLISHMENT OF 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 Early Ac-
cess Trust Fund’ (in this section 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
section 1859B shall be transferred to the Trust
Fund.
‘‘(3) TRANSFER OF SAVINGS FROM NEW FRAUD
AND ABUSE INITIATIVES.—
‘‘(A) IN GENERAL.—There is hereby trans-
ferred to the Trust Fund from the Federal
Hospital Insurance Trust Fund and from the
Federal 
Supplementary 
Medical 
Insurance
Trust Fund amounts equivalent to the amounts
(specified under subparagraph (B)) of the re-
ductions in expenditures under such respective
trust fund as may be attributable to the enact-
ment of the Medicare Fraud and Overpayment
Act of 2000.
‘‘(B) USE OF CBO ESTIMATES.—For each
fiscal year during the 10-fiscal-year period be-
ginning with fiscal year 2001, the amounts
under subparagraph (A) shall be the amounts
described in such subparagraph as determined
by the Congressional Budget Office at the time
of, and in connection with, the enactment of the
Early Medicare Access and Affordability Act of
2000. For subsequent fiscal years, the amounts
under subparagraph (A) shall be the amount
determined under this subparagraph for the
previous fiscal year increased by the same per-
centage as the percentage increase in aggregate
expenditures under this title from the second
previous fiscal year to the previous fiscal year.
‘‘(b) INCORPORATION OF PROVISIONS.—
‘‘(1) IN GENERAL.—Subject to paragraph (2),
subsections (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 Federal Supplementary Medical Insurance Trust
Fund and part B, respectively.
‘‘(2) MISCELLANEOUS REFERENCES.—In apply-
ing provisions of section 1841 under paragraph
(1)—
‘‘(A) any reference in such section to ‘this
part’ is construed to refer to this part D;
‘‘(B) any reference in section 1841(h) to
section 1840(d) and in section 1841(i) to sec-
tions 1840(b)(1) and 1842(g) are deemed ref-
erences to comparable authority exercised under
this part; and
‘‘(C) payments may be made under section
1841(g) to the Trust Funds under sections
1817 and 1841 as reimbursement to such funds
for payments they made for benefits provided
under this part.
‘‘SEC. 1859E. OVERSIGHT AND ACCOUNTABILITY.
‘‘(a) THROUGH ANNUAL REPORTS OF TRUSTEES.—
The Board of Trustees of the Medicare Early Access
Trust Fund under section 1859D(b)(1) shall report on an
annual basis to Congress concerning the status of the
Trust Fund and the need for adjustments in the program
under this part to maintain financial solvency of the pro-
gram under this part.
‘‘(b) PERIODIC GAO REPORTS.—The Comptroller
General of the United States shall periodically submit to
Congress reports on the adequacy of the financing of cov-
erage provided under this part. The Comptroller General
shall include in such report such recommendations for ad-
justments in such financing and coverage as the Comp-
troller General deems appropriate in order to maintain fi-
nancial solvency of the program under this part.
‘‘SEC. 1859F. ADMINISTRATION AND MISCELLANEOUS.
‘‘(a) TREATMENT FOR PURPOSES OF TITLE.—Ex-
cept as otherwise provided in this part—
‘‘(1) individuals enrolled under this part shall
be treated for purposes of this title as though the in-
dividual were entitled to benefits under part A and
enrolled under part B; and
‘‘(2) benefits described in section 1859 shall be
payable under this title to such individuals in the
same manner as if such individuals were so entitled
and enrolled.
‘‘(b) NOT TREATED AS MEDICARE PROGRAM FOR
PURPOSES OF MEDICAID PROGRAM.—For purposes of ap-
plying title XIX (including the provision of Medicare cost-
sharing assistance under such title), an individual who is
enrolled under this part shall not be treated as being enti-
tled to benefits under this title.
‘‘(c) NOT TREATED AS MEDICARE PROGRAM FOR
PURPOSES OF COBRA CONTINUATION PROVISIONS.—In
applying a COBRA continuation provision (as defined in
section 2791(d)(4) of the Public Health Service Act), any
reference to an entitlement to benefits under this title
shall not be construed to include entitlement to benefits
under this title pursuant to the operation of this part.’’.
(b) CONFORMING AMENDMENTS TO SOCIAL SECU-
RITY ACT PROVISIONS.—