Medicare Buy-In and Health Care Stabilization Act of 2021

I 117TH CONGRESS 1ST SESSION H. R. 2881 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 APRIL 28, 2021 Mr. HIGGINS of New York (for himself, Mr. LARSON of Connecticut, Mr. COURTNEY, and Mr. WELCH) introduced the following bill; which was re- ferred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently de- termined 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- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Medicare Buy-In and 4 Health Care Stabilization Act of 2021’’. 5 VerDate Sep 11 2014 23:32 Jun 08, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H2881.IH H2881 kjohnson on DSK79L0C42PROD with BILLS 2 •HR 2881 IH SEC. 2. FINDINGS. 1 Congress finds as follows: 2 (1) Medicare has coverage gaps and should pro- 3 vide more comprehensive coverage, including increas- 4 ing coverage for the medical needs of beneficiaries 5 relating to hearing, dental, and vision care. 6 (2) Special needs populations face financial 7 challenges to secure coverage for Medicare’s out of 8 pocket costs and other hurdles. 9 (3) Medicare Buy-In is a step in the right di- 10 rection as Congress considers additional needed leg- 11 islation to address these and other coverage issues 12 and beneficiary financial challenges in Medicare and 13 Medicare Buy-In. 14 SEC. 3. MEDICARE BUY-IN OPTION. 15 (a) IN GENERAL.—Title XVIII of the Social Security 16 Act (42 U.S.C. 1395c et seq.) is amended by adding at 17 the end the following new section: 18 ‘‘MEDICARE BUY-IN OPTION 19 ‘‘SEC. 1899C. (a) OPTION.— 20 ‘‘(1) IN GENERAL.—Every individual who meets 21 the requirements described in paragraph (2) shall be 22 eligible to enroll under this section. 23 ‘‘(2) ELIGIBILITY.—An individual who meets 24 the following requirements is eligible to enroll under 25 this section: 26 VerDate Sep 11 2014 23:32 Jun 08, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H2881.IH H2881 kjohnson on DSK79L0C42PROD with BILLS 3 •HR 2881 IH ‘‘(A) AGE.—The individual has attained 50 1 years of age, but has not attained 65 years of 2 age. 3 ‘‘(B) MEDICARE ELIGIBILITY (BUT FOR 4 AGE).—The individual is not otherwise entitled 5 to benefits under part A or eligible to enroll 6 under part A or part B but would be eligible for 7 benefits under part A or part B if the indi- 8 vidual were 65 years of age. 9 ‘‘(3) PART A, B, AND D BENEFITS AND PROTEC- 10 TIONS.—An individual enrolled under this section is 11 entitled to the same benefits (and shall receive the 12 same protections) under this title as an individual 13 who is entitled to benefits under part A and enrolled 14 under parts B and D, including the ability to enroll 15 in a Medicare Advantage plan that provides qualified 16 prescription drug coverage (an MA–PD plan) and 17 including access to the Medicare Beneficiary Om- 18 budsman under section 1808(c). 19 ‘‘(b) ENROLLMENT AND COVERAGE PERIODS.—The 20 Secretary shall establish enrollment and coverage periods 21 for individuals who enroll under this section. Such periods 22 shall be established in coordination with the enrollment 23 and coverage periods for plans offered under an Exchange 24 established under title I of the Patient Protection and Af- 25 VerDate Sep 11 2014 23:32 Jun 08, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H2881.IH H2881 kjohnson on DSK79L0C42PROD with BILLS 4 •HR 2881 IH fordable Care Act. The Secretary shall establish such peri- 1 ods so that coverage under this section shall first begin 2 on January 1 of the first year beginning at least one year 3 after the date of the enactment of this section and shall 4 include special enrollment periods, in accordance with sec- 5 tion 155.420 of title 45 of the Code of Federal Regula- 6 tions, that are applicable to qualified health plans offered 7 through an Exchange. 8 ‘‘(c) BUY-IN PREMIUM.— 9 ‘‘(1) AMOUNT OF MONTHLY PREMIUMS.—The 10 Secretary shall (beginning for the first year that be- 11 gins more than 1 year after the date of the enact- 12 ment of this section), during September of the pre- 13 ceding year, determine a monthly premium for indi- 14 viduals enrolled under this section. Such monthly 15 premium shall be equal to 1⁄12 of the annual pre- 16 mium computed under paragraph (2)(B), which 17 shall apply with respect to coverage provided under 18 this section for any month in such year. 19 ‘‘(2) ANNUAL PREMIUM.— 20 ‘‘(A) COMBINED NATIONAL, PER CAPITA 21 AVERAGE FOR PARTS A, B, AND D BENEFITS.— 22 The Secretary shall estimate the average, an- 23 nual per capita amount for benefits and admin- 24 istrative expenses that will be payable under 25 VerDate Sep 11 2014 23:32 Jun 08, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H2881.IH H2881 kjohnson on DSK79L0C42PROD with BILLS 5 •HR 2881 IH parts A, B, and D in the year for all individuals 1 enrolled under this section. 2 ‘‘(B) ANNUAL PREMIUM.—Subject to sub- 3 paragraphs (C) and (D), the annual premium 4 under this subsection for months in a year is 5 equal to the average, annual per capita amount 6 estimated under subparagraph (A) for the year. 7 ‘‘(C) ADJUSTMENTS.—The Secretary shall 8 adjust the annual premium under this sub- 9 section as necessary— 10 ‘‘(i) to ensure that expenditures under 11 this title for any year are not increased by 12 reason of this section; and 13 ‘‘(ii) by a geographic adjustment fac- 14 tor to address regional affordability con- 15 cerns. 16 ‘‘(D) AUTHORITY TO CALCULATE 17 AMOUNTS OF MONTHLY PREMIUMS SEPARATELY 18 FOR DIFFERENT AGES.—In determining the an- 19 nual premium amount under this paragraph for 20 months in a year, the Secretary may make sep- 21 arate determinations of such amount for indi- 22 viduals by age, if the Secretary determines that 23 making such separate determinations would in- 24 VerDate Sep 11 2014 23:32 Jun 08, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H2881.IH H2881 kjohnson on DSK79L0C42PROD with BILLS 6 •HR 2881 IH crease enrollment under this section and reduce 1 the risk of adverse selection. 2 ‘‘(3) ADDITIONAL PREMIUM FOR CERTAIN PART 3 D PLANS.—Nothing in this section shall preclude an 4 individual from choosing a prescription drug plan 5 which requires the individual to pay an additional 6 amount (because of the inclusion of supplemental 7 prescription drug benefits or because the plan is a 8 more expensive plan, pursuant to section 1860D– 9 13(a)(1)). In such case, the monthly premium under 10 paragraph (1) shall be increased with respect to 11 such individual. 12 ‘‘(d) PAYMENT OF PREMIUMS.— 13 ‘‘(1) PAYMENT.—Premiums for enrollment 14 under this section shall be paid to the Secretary at 15 such times, and in such manner, as the Secretary 16 determines appropriate. 17 ‘‘(2) DEPOSIT.—Amounts collected by the Sec- 18 retary under this section shall be deposited in the 19 Medicare Buy-In Trust Fund established under sub- 20 section (e). 21 ‘‘(e) MEDICARE BUY-IN TRUST FUND.— 22 ‘‘(1) IN GENERAL.—There is hereby created on 23 the books of the Treasury of the United States a 24 trust fund to be known as the ‘Medicare Buy-In 25 VerDate Sep 11 2014 23:32 Jun 08, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H2881.IH H2881 kjohnson on DSK79L0C42PROD with BILLS 7 •HR 2881 IH Trust Fund’ (in this subsection referred to as the 1 ‘Trust Fund’). The Trust Fund shall consist of such 2 gifts and bequests as may be made as provided in 3 section 201(i)(1) and such amounts as may be de- 4 posited in, or appropriated to, such fund as provided 5 in this title. 6 ‘‘(2) PREMIUMS.—Premiums collected under 7 subsection (d) shall be transferred to the Trust 8 Fund. 9 ‘‘(3) INCORPORATION OF PROVISIONS.—Sub- 10 sections (b) through (i) of section 1841 shall apply 11 with respect to the Trust Fund and this title in the 12 same manner as they apply with respect to the Fed- 13 eral Supplementary Medical Insurance Trust Fund 14 and part B, respectively, except that in applying 15 such section 1841, any reference in such section to 16 ‘this part’ shall be construed to be a reference to 17 this section and any reference in section 1841(h) to 18 section 1840(d) and in section 1841(i) to sections 19 1840(b)(1) and 1842(g) are deemed to be references 20 to comparable authority exercised under this section. 21 ‘‘(f) CLARIFICATION.—Nothing in this section shall 22 affect the benefits or eligibility under this title of individ- 23 uals who would otherwise be entitled to or eligible for ben- 24 efits under this title or title XIX, or both. 25 VerDate Sep 11 2014 23:32 Jun 08, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H2881.IH H2881 kjohnson on DSK79L0C42PROD with BILLS 8 •HR 2881 IH ‘‘(g) ELIGIBILITY FOR FINANCIAL ASSISTANCE.— 1 ‘‘(1) IN GENERAL.—Individuals enrolled in cov- 2 erage under this section shall, from amounts trans- 3 ferred under paragraph (2), receive financial assist- 4 ance for such coverage that is substantially similar 5 to the assistance the individual would have received 6 if the individual were enrolled in a qualified health 7 plan through an Exchange. 8 ‘‘(2) TRANSFER OF FUNDS TO MEDICARE BUY- 9 IN TRUST FUND.— 10 ‘‘(A) IN GENERAL.—The Secretary shall 11 transfer to the Medicare Buy-In Trust Fund 12 under subsection (d) for each plan year the 13 amount determined under paragraph (C) for 14 such year. 15 ‘‘(B) USE OF FUNDS.—The amounts 16 transferred to the Medicare Buy-In Trust Fund 17 under subparagraph (A) shall only be used to 18 reduce the premiums and cost-sharing for cov- 19 erage under this section of individuals enrolled 20 under such coverage who would be eligible for 21 cost-sharing reductions under section 1402 of 22 the Patient Protection and Affordable Care Act 23 and premium assistance under section 36B of 24 VerDate Sep 11 2014 23:32 Jun 08, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H2881.IH H2881 kjohnson on DSK79L0C42PROD with BILLS 9 •HR 2881 IH the Internal Revenue Code of 1986 if such indi- 1 vidual were enrolled in a qualified health plan. 2 ‘‘(C) AMOUNT OF TRANSFER.— 3 ‘‘(i) IN GENERAL.—The amount de- 4 termined under this subparagraph for any 5 plan year is the aggregate amount the Sec- 6 retary determines is equal to 100 percent 7 of the premium tax credits under section 8 36B of the Internal Revenue Code of 9 1986, and 100 percent of the cost-sharing 10 reductions under section 1402 of the Pa- 11 tient Protection and Affordable Care Act, 12 that would have been provided for the plan 13 year to eligible individuals who meet speci- 14 fied income criteria and are enrolled for 15 such plan year in coverage provided 16 through enrollment under this section if 17 such individuals were enrolled for such 18 year in a qualified health plan through an 19 Exchange. 20 ‘‘(ii) SPECIFIC REQUIREMENTS.—The 21 Secretary shall make the determination 22 under clause (i) on a per enrollee basis and 23 shall take into account all relevant factors 24 necessary to determine the value of the 25 VerDate Sep 11 2014 23:32 Jun 08, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H2881.IH H2881 kjohnson on DSK79L0C42PROD with BILLS 10 •HR 2881 IH premium tax credits and cost-sharing re- 1 ductions that would have been provided to 2 eligible individuals described in section 3 1331 of the Patient Protection and Afford- 4 able Care Act, including the age and in- 5 come of the enrollee, geographic differences 6 in average spending for health care across 7 rating areas, the health status of the en- 8 rollee for purposes of determining risk ad- 9 justment payments and reinsurance pay- 10 ments that would have been made if the 11 enrollee had enrolled in a qualified health 12 plan through an Exchange, and whether 13 any reconciliation of the credit or cost- 14 sharing reductions would have occurred if 15 the enrollee had been so enrolled. This de- 16 termination shall take into consideration 17 the experience of other States with respect 18 to participation in an Exchange and such 19 credits and reductions provided to resi- 20 dents of the other States, with a special 21 focus on enrollees with income below 200 22 percent of poverty. 23 ‘‘(D) CERTIFICATION.— 24 VerDate Sep 11 2014 23:32 Jun 08, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H2881.IH H2881 kjohnson on DSK79L0C42PROD with BILLS 11 •HR 2881 IH ‘‘(i) IN GENERAL.—The Chief Actuary 1 of the Centers for Medicare & Medicaid 2 Services, in consultation with the Office of 3 Tax Analysis of the Department of the 4 Treasury, shall certify whether the method- 5 ology used to make determinations under 6 subparagraph (C), and such determina- 7 tions, meet the requirements of this para- 8 graph. Such certifications shall be based 9 on sufficient data from the federal ex- 10 change and from comparable States about 11 their experience with programs created by 12 the Basic Health Plan. 13 ‘‘(ii) CORRECTIONS.—The Secretary 14 shall adjust the payment to the Trust 15 Fund for any plan year to reflect any error 16 in the determinations under subparagraph 17 (C) for any preceding plan year. 18 ‘‘(iii) APPLICATION.—Coverage pro- 19 vided through enrollment under this part 20 and parts B and D pursuant to this sec- 21 tion shall be treated as coverage under a 22 qualified health plan in the silver level of 23 coverage in the individual market offered 24 VerDate Sep 11 2014 23:32 Jun 08, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H2881.IH H2881 kjohnson on DSK79L0C42PROD with BILLS 12 •HR 2881 IH through an Exchange and the Secretary 1 shall be treated as the issuer of such plan. 2 ‘‘(h) TREATMENT IN RELATION TO THE AFFORD- 3 ABLE CARE ACT.— 4 ‘‘(1) TREATMENT AS MINIMUM ESSENTIAL COV- 5 ERAGE.—For purposes of applying section 5000A of 6 the Internal Revenue Code of 1986, the coverage 7 provided through enrollment under this section con- 8 stitutes minimum essential coverage under sub- 9 section (f)(1)(A)(i) of such section. 10 ‘‘(2) USE OF EXCHANGES.—Coverage provided 11 through enrollment under this section shall be 12 deemed to be coverage under a qualified health plan [Text truncated for display. Full text available on Congress.gov.]