Expanding Health Care Options for First Responders 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.
[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6030 Introduced in House (IH)]
<DOC>
118th CONGRESS
1st Session
H. R. 6030
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.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
October 24, 2023
Mr. Phillips (for himself, Ms. Brownley, Mr. Casten, Ms. Lois Frankel
of Florida, Ms. Kaptur, Mr. Neguse, Mr. Soto, Ms. Titus, and Mr.
Veasey) introduced the following bill
October 25, 2023
Referred to the Committee on Ways and Means, and in addition to the
Committee on Energy and Commerce, 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 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
First Responders 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.
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; 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 first 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.''.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, 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.
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, 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.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
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