,,ii #aaeth ,,congress #ast ,session ,s4 #agdb ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,august #c1 #bjag,ms4 ,stabenow 7for herself1 ,mr4 ,brown1 ,ms4 ,baldwin1 ,mr4 ,whitehouse1 ,mr4 ,leahy1 ,mr4 ,merkley1 ,mr4 ,reed1 ,mr4 ,franken1 and ,mr4 ,booker7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend title ,,xviii of the ,social ,security ,act to provide for an option for any citizen or permanent resident of the ,united ,states age #ee to #fd to buy into ,medicare4 #a4 ,short title ,this ,act may be cited as the ,medicare at #ee ,act4 #b4 ,medicare buy-in option for individuals #ee to #fd years of age 7a7 ,in general ,title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;c et seq47 is amended by adding at the end the following new section3 #ahii;,c4 ,medicare buy-in option for individuals #ee to #fd years of age 7a7 ,option 7#a7 ,in general ,every individual who meets the requirements described in paragraph 7#c7 shall be eligible to enroll under this section4 7#b7 ,part ,a1 ,b1 and ,d benefits ,an individual enrolled under this section is entitled to the same benefits 7and shall receive the same protections7 under this title as an individual who is entitled to benefits under part ,a and enrolled under parts ,b and ,d1 including the ability to enroll in a ,medicare ,advantage plan that provides qualified prescription drug coverage 7an ,,ma-,,pd plan74 7#c7 ,requirements for eligibility ,the requirements described in this paragraph are the following3 7,a7 ,the individual is a resident of the ,united ,states4 7,b7 ,the individual is-- 7i7 a citizen or national of the ,united ,states2 or 7ii7 an alien lawfully admitted for permanent residence4 7,c7 ,the individual is not otherwise entitled to benefits under part ,a or eligible to enroll under part ,a or part ,b4 7,d7 ,the individual has attained #ee years of age but has not attained #fe years of age4 7b7 ,enrollment2 coverage ,the ,secretary shall establish enrollment periods and coverage under this section consistent with the principles for establishment of enrollment periods and coverage for individuals under other provisions of this title4 ,the ,secretary shall establish such periods so that coverage under this section shall first begin on ,january #a1 #bjai4 7c7 ,premium 7#a7 ,amount of monthly premiums ,the ,secretary shall1 during ,september of each year 7beginning with #bjah71 determine a monthly premium for all individuals enrolled under this section4 ,such monthly premium shall be equal to #a_/ab of the annual premium computed under paragraph 7#b77;,b71 which shall apply with respect to coverage provided under this section for any month in the succeeding year4 7#b7 ,annual premium 7,a7 ,combined per capita average for all ,medicare benefits ,the ,secretary shall estimate the average1 annual per capita amount for benefits and administrative expenses that will be payable under parts ,a1 ,b1 and ,d 7including1 as applicable1 under part ,c7 in the year for all individuals enrolled under this section4 7,b7 ,annual premium ,the annual premium under this subsection for months in a year is equal to the average1 annual per capita amount estimated under subparagraph 7,a7 for the year4 7#c7 ,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 7because of supplemental benefits or because it is a more expensive plan74 ,in such case the individual would be responsible for the increased monthly premium4 7d7 ,payment of premiums 7#a7 ,in general ,premiums for enrollment under this section shall be paid to the ,secretary at such times1 and in such manner1 as the ,secretary determines appropriate4 7#b7 ,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 7including the ,medicare ,prescription ,drug ,account within such ,trust ,fund7 in such proportion as the ,secretary determines appropriate4 7e7 ,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 ,,xix4 7f7 ,treatment in relation to the ,affordable ,care ,act 7#a7 ,satisfaction of individual mandate ,for purposes of applying section #ejjj;,a of the ,internal ,revenue ,code of #aihf1 the coverage provided under this section constitutes minimum essential coverage under subsection 7f77#a77;,a77i7 of such section #ejjj;,a4 7#b7 ,eligibility for premium assistance ,coverage provided under this section-- 7,a7 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 #cf;,b of the ,internal ,revenue ,code of #aihf other than subsection 7c77#b77;,b7 thereof2 and 7,b7 shall not be treated as eligibility for other minimum essential coverage for purposes of subsection 7c77#b77;,b7 of such section #cf;,b4 ,the ,secretary shall determine the applicable second lowest cost silver plan which shall apply to coverage under this section for purposes of section #cf;,b of such ,code4 7#c7 ,eligibility for cost-sharing subsidies ,for purposes of applying section #adjb of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjga7-- 7,a7 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 ,exchange2 and 7,b7 the ,secretary shall be treated as the issuer of such plan4 7g7 ,guaranteed issue of ,medigap policies upon first enrollment and each subsequent enrollment ,in the case of an individual who enrolls under this section 7including an individual who was previously enrolled under this section71 paragraphs 7#b77;,a71 7#b77;,d71 7#c77;,b77ii71 and 7#c77;,b77vi7 of section #ahhb7s7-- 7#a7 shall be applied by substituting #ee for #fe2 7#b7 if the individual was enrolled under this section and subsequently disenrolls1 shall apply each time the individual subsequently reenrolls under this section as if the individual had attained #ee years of age on the date of such reenrollment 7and as if the individual had never previously enrolled in a ,medicare supplemental policy72 and 7#c7 shall be applied as if this section had not been enacted 7and as if the individual had never previously enrolled in a ,medicare supplemental policy7 when the individual attains #fe years of age4 7h7 ,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-- 7#a7 have no effect on the benefits under this title for individuals who are entitled to1 or enrolled for1 such benefits other than through this section2 and 7#b7 have no negative impact on the ,federal ,hospital ,insurance ,trust ,fund or the ,federal ,supplementary ,medical ,insurance ,trust ,fund 7including the ,medicare ,prescription ,drug ,account within such ,trust ,fund74 7i7 ,consultation ,in promulgating regulations to implement this section1 the ,secretary shall consult with interested parties1 including groups representing beneficiaries1 health care providers1 employers1 and insurance companies4 4