,i #aaeth ,,congress #ast ,session ,h4 ,r4 #gjg ,,in ,,the ,,house ,,of ,,representatives ,january #bg1 #bjag,mrs4 ,blackburn introduced the following bill2 which was referred to the ,committee on ,ways and ,means1 and in addition to the ,committee on ,energy and ,commerce1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to amend the ,social ,security ,act to improve choices available to ,medicare eligible seniors by permitting them to elect 7instead of regular ,medicare benefits7 to receive a voucher for a health savings account1 for premiums for a high deductible health insurance plan1 or both and by suspending ,medicare late enrollment penalties between ages #fe and #gj4 #a4 ,short title ,this ,act may be cited as the ,health ,care ,choices for ,seniors ,act4 #b4 ,findings ,congress finds the following3 7#a7 ,the ,social ,security ,administration's ,program ,operations ,manual ,system section ,,hi #jjhja4jjb1 titled ,waiver of ,hospital ,insurance ,entitlement by ,monthly ,beneficiary1 provides that an individual who does not sign up for part ,a of the ,medicare program when the individual signs up for social security benefits will lose such benefits1 regardless of the desire of the individual to not participate in the ,medicare program because of religious or philosophical reasons or a preference to have private health insurance4 7#b7 ,as part of the ,medicare ,prescription ,drug1 ,improvement1 and ,modernization ,act of #bjjc 7,public ,law #ajh-agc71 ,congress increased health insurance options by authorizing health savings accounts into which individuals may make annual contributions of not more than #b1fej and families may make such contributions of not more than #e1bej that are allowable as deductions for income tax purposes4 ,seniors are not allowed to deduct contributions to their health savings account after the date of the entitlement of such seniors to ,medicare benefits4 7#c7 ,section #ahjb7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;a7b771 added by section #dejg of the ,balanced ,budget ,act of #aiig1 states that a ,medicare beneficiary may only enter into a private contract with a physician for an item or service if no claim for payment under title ,,xviii of such ,act will be submitted4 ,in the case of such contract1 the physician must sign an affidavit that acknowledges such contract and that provides that the physician will not submit a claim1 and will forgo reimbursement1 under such title for an item or service provided to any ,medicare beneficiary for a period of two years4 #c4 ,authority to elect voucher program instead of ,medicare part ,a entitlement 7a7 ,in general ,section #bbf of the ,social ,security ,act 7#db ,u4,s4,c4 #dbf7 is amended by adding at the end the following new subsections3 7k7 ,waiver of entitlement and election of voucher program 7#a7 ,in general ,notwithstanding the previous provisions of this section1 the ,secretary shall establish a procedure under which an individual otherwise entitled under subsection 7a7 to benefits under part ,a of title ,,xviii may waive such entitlement and be automatically enrolled in the ,medicare ,alternative ,voucher ,program established under subsection 7l7 if-- 7,a7 at the time such waiver is made the individual-- 7i7 has a health savings account described in subsection 7d7 of section #bbc of the ,internal ,revenue ,code of #aihf 7#bf ,u4,s4,c4 #bbc72 and 7ii7 is enrolled under a high deductible health plan1 as defined in subsection 7c77#a7 of such section2 and 7,b7 the individual makes such waiver during the initial enrollment period described in section #ahcg7;d74 7#b7 ,treatment under the ,internal ,revenue ,code of #aihf ,an individual who waives entitlement under paragraph 7#a7 shall not be treated as entitled to benefits under title ,,xviii for purposes of section #bbc7;b77#g7 of the ,internal ,revenue ,code of #aihf4 7#c7 ,ineligibility for part ,b or ,d benefits ,an individual shall not be eligible for benefits under part ,b or ,d of title ,,xviii during the period for which the individual waives entitlement under part ,a of such title under paragraph 7#a74 7#d7 ,termination of waiver and reenrollment under ,medicare program ,the ,secretary shall establish a procedure under which an individual who waives entitlement under paragraph 7#a7 may terminate such waiver during an annual period that shall be the same as the annual general enrollment period described in section #ahcg7;e74 ,for purposes of applying parts ,b and ,d of title ,,xviii1 such individual shall be treated as if the individual were entitled to benefits under part ,a of such title as of the date such individual terminates the waiver under this paragraph4 ,an individual who has terminated such a waiver may not subsequently make such a waiver4 7l7 ,medicare ,alternative ,voucher ,program 7#a7 ,establishment of program ,the ,secretary shall establish a program to be known as the ,medicare ,alternative ,voucher ,program 7in this subsection referred to as the voucher program7 consistent with this subsection4 7#b7 ,automatic enrollment ,an individual who waives entitlement under subsection 7k77#a7 shall be enrolled in the voucher program for the period during which such waiver is in effect4 7#c7 ,amount of voucher 7,a7 ,amount based on age cohort 7i7 ,in general ,subject to clause 7ii71 for each month that an individual within an age cohort is enrolled in the voucher program1 the ,secretary shall provide a voucher to such individual in an amount that is equal to the monthly actuarial rate for that month computed under section #ahah7;d77#a7 multiplied by the age cohort adjustment factor for such age cohort under subparagraph 7,b74 7ii7 ,monthly limit ,the amount of a voucher provided to an individual for a month may not exceed #bjj4 7,b7 ,age cohort adjustment factor ,for each age cohort the ,secretary shall determine an age cohort adjustment factor equal to the ratio of-- 7i7 the monthly actuarial rate described in section #ahah7;d77#a7 as determined by the ,secretary for individuals in such age cohort1 to 7ii7 the monthly actuarial rate described in such section4 7,c7 ,age cohort defined ,for purposes of this paragraph1 an age cohort means a group of individuals whose age falls within a span of five consecutive years1 consistent with the following3 7i7 ,the first such span begins at age #fe4 7ii7 ,other spans follow consecutively4 7#d7 ,permissible use of voucher ,a voucher under paragraph 7#c7 may be used only for the following purposes3 7,a7 ,as a contribution into a health savings account established by such individual1 as described in subsection 7k77#a77;,a74 7,b7 ,for payment of premiums for enrollment of such individual under a high deductible health plan described in such subsection4 7#e7 ,effect of subsequent termination of waiver ,if an individual terminates a waiver under subsection 7k77#d71 the enrollment of such individual in the voucher program shall be terminated on the date on which the termination becomes effective4 4 7b7 ,amendment of ,internal ,revenue ,code of #aihf ,paragraph 7#g7 of section #bbc7;b7 of the ,internal ,revenue ,code of #aihf 7relating to ,medicare eligible individuals7 is amended to read as follows3 7#g7 ,medicare eligible individuals 7,a7 ,in general ,the limitation under this subsection for any month with respect to an individual shall be zero for any month such individual is entitled to benefits under title ,,xviii of the ,social ,security ,act4 7,b7 ,medicare alternative voucher program ,in the case of an individual who is enrolled in the ,medicare ,alternative ,voucher ,program under section #bbf7l7 of the ,social ,security ,act1 the applicable limitation under subparagraphs 7,a7 and 7,b7 of paragraph 7#b7 shall be increased by the amount of the voucher described in paragraph 7#c7 of such section which is contributed to a health savings account of such individual4 4 7c7 ,effective date 7#a7 ,in general ,the amendment made by subsection 7a7 shall take effect on the date that is six months after the date of the enactment of this ,act and shall apply to an individual who becomes entitled to benefits under part ,a of title ,,xviii of the ,social ,security ,act on or after such date of the enactment4 7#b7 ,amendment of ,internal ,revenue ,code of #aihf ,the amendment made by subsection 7b7 shall apply to months ending after the date referred to in paragraph 7#a71 in taxable years ending after such date4 #d4 ,suspension of ,medicare late enrollment penalties between ages #fe and #gj 7a7 ,part ,b ,the second sentence of section #ahci7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acier7b77 is amended by inserting before the period the following3 and there shall not be taken into account 7for individuals not entitled to benefits under section #bbf;,a7 any month during any part of which the individual attained age #fe and has not attained age #gj4 7b7 ,part ,d 7#a7 ,in general ,section #ahfj;,d-#ac7;b77#g77;,a7 of such ,act 7#db ,u4,s4,c4 #aciew-#aac7;b77#g77;,a77 is amended by adding at the end the following sentence3 ,for purposes of the preceding sentence1 in the case of an individual not entitled to benefits under part ,a under section #bbf;,a1 a continuous period of eligibility shall not include any month during any part of which the individual attained age #fe and has not attained age #gj44 7#b7 ,conforming amendment ,section #ahfj;,d-#a7;b77#f77;,a7 of such ,act 7#db ,u4,s4,c4 #aciew-#aja7;b77#f77;,a77 is amended by inserting after paragraph 7#b7 the following3 1 but excluding the period between #fe and #gj years of age4 7c7 ,effective date ,the amendments made by this section shall apply to individuals who attain #fe years of age in a month after the month in which this ,act is enacted4