Expanding Health Care Options for Early Retirees Act
Bill: H.R.4148 | Sponsor: Rep. Malinowski, Tom (D-NJ)
Policy area: Health

Summary:
Expanding Health Care Options for Early Retirees Act
This bill establishes a Medicare buy-in option for certain qualifying first responders.
Specifically, the bill allows first responders aged 50 to 64 to enroll in Medicare if they are retired or otherwise separated from service due to a disability. The Centers for Medicare & Medicaid Services (CMS) must determine enrollment periods and set premiums for the buy-in option established under the bill, in accordance with specified requirements. The CMS must also award grants to states and nonprofit organizations for outreach and enrollment activities relating to the buy-in option.

To amend title XVIII of the Social Security Act to provide an option 
for first responders age 50 to 64 who are separated from service due to 
             retirement or disability to buy into Medicare.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Expanding Health Care Options for 
Early Retirees Act''.

SEC. 2. MEDICARE BUY-IN OPTION FOR FIRST RESPONDERS 50 TO 64 YEARS OF 
              AGE WHO ARE SEPARATED FROM SERVICE DUE TO RETIREMENT OR 
              DISABILITY.

    (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 for first responders 50 to 64 years of age who 
       are separated from service due to retirement or disability

    ``Sec. 1899C.  (a) Option.--
            ``(1) In general.--Every individual who meets the 
        requirements described in paragraph (3) shall be eligible to 
        enroll under this section.
            ``(2) Part a, b, and d benefits.--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).
            ``(3) Requirements for eligibility.--The requirements 
        described in this paragraph are the following:
                    ``(A) The individual is a resident of the United 
                States.
                    ``(B) The individual is--
                            ``(i) a citizen or national of the United 
                        States; or
                            ``(ii) an alien lawfully admitted for 
                        permanent residence.
                    ``(C) The individual is not otherwise entitled to 
                benefits under part A or eligible to enroll under part 
                A or part B.
                    ``(D) The individual has attained 50 years of age 
                but has not attained 65 years of age.
                    ``(E) The individual is a qualified first responder 
                (as defined in paragraph (4)(B)).
            ``(4) Definitions.--In this section:
                    ``(A) First responder.--The term `first responder' 
                means--
                            ``(i) a qualified law enforcement officer 
                        (as defined in section 926B(c) of title 18, 
                        United States Code);
                            ``(ii) an employee described in clause (i) 
                        of section 72(t)(10)(B) of the Internal Revenue 
                        Code of 1986 who provides firefighting services 
                        or emergency medical services; or
                            ``(iii) a Federal firefighter described in 
                        section 8331(21) or 8401(14) of title 5, United 
                        States Code.
                    ``(B) Qualified first responder.--The term 
                `qualified first responder' means a first responder who 
                is separated from service due to retirement or 
                disability.
    ``(b) Enrollment and Coverage Periods.--
            ``(1) In general.--The Secretary shall establish enrollment 
        and coverage periods for individuals who enroll under this 
        section.
            ``(2) Coordination.--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 Affordable Care Act and plans under 
        parts C and D. If the Secretary determines appropriate, the 
        Secretary may expand such enrollment periods beyond the 
        enrollment periods under such an Exchange or under parts C and 
        D.
            ``(3) Beginning of coverage and special enrollment 
        periods.--The Secretary shall establish such periods 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 section 155.420 of title 
        45 of the Code of Federal Regulations, that are applicable to 
        qualified health plans offered through an Exchange.
    ``(c) Premium.--
            ``(1) Amount of monthly premiums.--The Secretary shall 
        (beginning for the 1st year that begins more than 1 year after 
        the date of enactment of this section) determine a monthly 
        premium for all individuals enrolled under this section. Such 
        monthly premium shall be equal to \1/12\ of the annual premium 
        computed under paragraph (2)(B), which shall apply with respect 
        to coverage provided under this section for any month in the 
        succeeding year.
            ``(2) Annual premium.--
                    ``(A) Combined per capita average for all medicare 
                benefits.--The Secretary shall estimate the average, 
                annual per capita amount for benefits and 
                administrative expenses that will be payable under 
                parts A, B, and D (including, as applicable, under part 
                C) in the year for all individuals enrolled under this 
                section.
                    ``(B) Annual premium.--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.
            ``(3) Increased premium for certain part c and d plans.--
        Nothing in this section shall preclude an individual from 
        choosing a Medicare Advantage plan or a prescription drug plan 
        which requires the individual to pay an additional amount 
        (because of supplemental benefits or because it is a more 
        expensive plan). In such case the individual would be 
        responsible for the increased monthly premium.
    ``(d) Payment of Premiums.--
            ``(1) In general.--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 Secretary under 
        this section shall be deposited in the Federal Hospital 
        Insurance Trust Fund and the Federal Supplementary Medical 
        Insurance Trust Fund (including the Medicare Prescription Drug 
        Account within such Trust Fund) in such proportion as the 
        Secretary determines appropriate.
    ``(e) Not Eligible for Medicare Cost-Sharing Assistance.--An 
individual enrolled under this section shall not be treated as enrolled 
under any part of this title for purposes of obtaining medical 
assistance for Medicare cost-sharing or otherwise under title XIX.
    ``(f) Treatment in Relation to the Affordable Care Act.--
            ``(1) Satisfaction of individual mandate.--For purposes of 
        applying section 5000A of the Internal Revenue Code of 1986, 
        the coverage provided under this section constitutes minimum 
        essential coverage under subsection (f)(1)(A)(i) of such 
        section 5000A.
            ``(2) Eligibility for premium assistance.--Coverage 
        provided 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 individual 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.
        The Secretary shall determine the applicable second lowest cost 
        silver plan which shall apply to coverage under this section 
        for purposes of section 36B of such Code.
            ``(3) Eligibility for cost-sharing subsidies.--For purposes 
        of applying section 1402 of the Patient Protection and 
        Affordable Care Act (42 U.S.C. 18071)--
                    ``(A) coverage provided under this section shall be 
                treated as coverage under a qualified health plan in 
                the silver level of coverage in the individual market 
                offered through an Exchange; and
                    ``(B) the Secretary shall be treated as the issuer 
                of such plan.
            ``(4) Medicaid managed care.--States are prohibited from 
        buying their Medicaid beneficiaries ages 50 to 64 into Medicare 
        under this section, and individuals otherwise eligible for 
        enrollment under a State plan under title XIX are prohibited 
        from coverage 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).
            ``(5) Coordination with market reforms, etc.--
        Notwithstanding Treasury Notice 2015-17, no provision of law 
        shall prevent an employer from maintaining an arrangement under 
        which the employer pays or reimburses any portion of the 
        premiums for coverage under this section for retired employees 
        of the employer, or prevent such payment or reimbursement from 
        being excluded from the gross income of the individual enrolled 
        in such coverage for purposes of the Internal Revenue Code of 
        1986.
    ``(g) Guaranteed Issue of Medigap Policies Upon First Enrollment 
and Each Subsequent Enrollment.--In the case of an individual who 
enrolls under this section (including an individual who was previously 
enrolled under this section), paragraphs (2)(A), (2)(D), (3)(B)(ii), 
and (3)(B)(vi) of section 1882(s)--
            ``(1) shall be applied by substituting `50' for `65';
            ``(2) if the individual was enrolled under this section and 
        subsequently disenrolls, shall apply each time the individual 
        subsequently reenrolls under this section as if the individual 
        had attained 50 years of age on the date of such reenrollment 
        (and as if the individual had never previously enrolled in a 
        Medicare supplemental policy); and
            ``(3) shall be applied as if this section had not been 
        enacted (and as if the individual had never previously enrolled 
        in a Medicare supplemental policy) when the individual attains 
        65 years of age.
    ``(h) 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 enrolling under this section. The Medicare Buy In Oversight 
Board shall have members that include representatives of insurers, 
actuaries, consumer advocacy organizations, and individuals 
representing the first responder community, and shall make periodic 
recommendations for the continual improvement of the implementation of 
this section as well as the relationship of enrollment under this 
section to other health care programs.
    ``(i) Outreach and Enrollment.--
            ``(1) In general.--During the period that begins on January 
        1, 2022, and ends on December 31, 2024, 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 reductions.--To distribute fair and 
                impartial information concerning enrollment under this 
                section and the availability of premium assistance tax 
                credits under section 36B of the Internal Revenue 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.--
                    ``(A) In general.--In this subsection, the term 
                `eligible entity' means--
                            ``(i) a State;
                            ``(ii) a nonprofit community-based 
                        organization; or
                            ``(iii) a nonprofit first responder 
                        organization.
                    ``(B) Enrollment agents.--Such term includes a 
                licensed independent insurance agent or broker that has 
                an arrangement with a State, nonprofit community-based 
                organization, or nonprofit first responder 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 
                        insurance issuer in connection with the 
                        enrollment of any individuals under this 
                        section.
            ``(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.
            ``(4) Funding.--For purposes of carrying out this 
        subsection, there is appropriated to the Secretary, out of any 
        moneys in the Treasury not otherwise appropriated, such sums as 
        are necessary for calendar year 2022 and for each subsequent 
        calendar year.
    ``(j) No Effect on Benefits for Individuals Otherwise Eligible or 
on Trust Funds.--The Secretary shall implement the provisions of this 
section in such a manner to ensure that such provisions--
            ``(1) have no effect on the benefits under this title for 
        individuals who are entitled to, or enrolled for, such benefits 
        other than through this section; and
            ``(2) have no negative impact on the Federal Hospital 
        Insurance Trust Fund or the Federal Supplementary Medical 
        Insurance Trust Fund (including the Medicare Prescription Drug 
        Account within such Trust Fund).
    ``(k) Consultation.--In promulgating regulations to implement this 
section, the Secretary shall consult with interested parties, including 
groups representing beneficiaries, health care providers, employers, 
insurance companies, and organizations representing first 
responders.''.
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