,,ii #aahth ,,congress #ast ,session ,s4 #caac ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,october #bd1 #bjbc,mr4 ,brown 7for himself1 ,mr4 ,blumenthal1 and ,mr4 ,fetterman7 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 an option for first responders age #ej to #fd who are separated from service due to retirement or disability to buy into ,medicare4 #a4 ,short title ,this ,act may be cited as the ,expanding ,health ,care ,options for ,first ,responders ,act4 #b4 ,medicare buy-in option for first responders #ej to #fd years of age who are separated from service due to retirement or disability 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 first responders #ej to #fd years of age who are separated from service due to retirement or disability 7a7 ,in general ,every individual who meets the requirements described in subsection 7c7 shall be eligible to enroll under this section4 7b7 ,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 7c7 ,requirements for eligibility ,the requirements described in this subsection are the following3 7#a7 ,the individual is a resident of the ,united ,states4 7#b7 ,the individual is-- 7,a7 a citizen or national of the ,united ,states2 or 7,b7 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 #ej years of age but has not attained #fe years of age4 7#e7 ,the individual is a qualified first responder 7as defined in subsection 7d77#b774 7d7 ,definitions ,in this section3 7#a7 ,first responder ,the term first responder means-- 7,a7 a qualified law enforcement officer 7as defined in section #ibf;,b7c7 of title #ah1 ,united ,states ,code72 7,b7 an employee described in clause 7i7 of section #gb7t77#aj77;,b7 of the ,internal ,revenue ,code of #aihf2 or 7,c7 a ,federal firefighter described in section #hcca7ba7 or #hdja7ad7 of title #e1 ,united ,states ,code4 7#b7 ,qualified first responder ,the term qualified first responder means a first responder who is separated from service due to retirement or disability4 7e7 ,enrollment and coverage periods 7#a7 ,in general ,the ,secretary shall establish enrollment and coverage periods for individuals who enroll under this section4 7#b7 ,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 ,d4 ,if the ,secretary determines appropriate1 the ,secretary may expand such enrollment periods beyond the enrollment periods under such an ,exchange or under parts ,c and ,d4 7#c7 ,beginning of coverage and special enrollment periods ,the ,secretary shall establish such periods so that coverage under this section shall first begin on ,january #a of the first year beginning at least #a year after the date of the enactment of this section and shall include special enrollment periods1 in accordance with section #aee4dbj of title #de of the ,code of ,federal ,regulations1 that are applicable to qualified health plans offered through an ,exchange4 7f7 ,premium 7#a7 ,amount of monthly premiums ,the ,secretary shall 7beginning for the first year that begins more than #a year after the date of enactment of this section7 determine a monthly premium for all individuals enrolled under this section4 ,such monthly premium shall be equal to #aab 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 7g7 ,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 7h7 ,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 7i7 ,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 #aihf1 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 7#c7 ,second lowest cost silver plan ,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 the ,internal ,revenue ,code of #aihf4 7#d7 ,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 7#e7 ,medicaid managed care ,states are prohibited from buying their ,medicaid beneficiaries ages #ej to #fd into ,medicare under this section1 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 section4 ,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 #a4ejjj;,a-#b of title #bf1 ,code of ,federal ,regulations 7or any successor regulation74 7#f7 ,coordination with market reforms1 etc ,notwithstanding ,treasury ,notice #bjae-ag1 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 employer1 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 #aihf4 7j7 ,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 #ej 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 #ej 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 7k7 ,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 section1 including the experience of the individuals enrolling under this section4 ,the ,medicare ,buy ,in ,oversight ,board shall have members that include representatives of insurers1 actuaries1 consumer advocacy organizations1 and individuals representing the first responder community1 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 programs4 7l7 ,outreach and enrollment 7#a7 ,in general ,during the period that begins on ,january #a1 #bjbd1 and ends on ,december #ca1 #bjbf1 the ,secretary shall award grants to eligible entities for the following purposes3 7,a7 ,outreach and enrollment ,to carry out outreach1 public education activities1 and enrollment activities to raise awareness of the availability of1 and encourage1 enrollment under this section4 7,b7 ,assisting individuals' transition under this section ,to provide assistance to individuals to enroll under this section4 7,c7 ,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 #cf;,b of the ,internal ,revenue ,code of #aihf and cost-sharing reductions under section #adjb of the ,patient ,protection and ,affordable ,care ,act1 and to assist eligible individuals in applying for such tax credits and cost-sharing reductions4 7#b7 ,eligible entities 7,a7 ,in general ,in this subsection1 the term eligible entity means-- 7i7 a ,state2 7ii7 a nonprofit community-based organization2 or 7iii7 a nonprofit first responder organization4 7,b7 ,enrollment agents ,such term includes a licensed independent insurance agent or broker that has an arrangement with a ,state1 nonprofit community-based organization1 or nonprofit first responder organization to enroll eligible individuals under this section4 7,c7 ,exclusions ,such term does not include an entity that-- 7i7 is a health insurance issuer2 or 7ii7 receives any consideration1 either directly or indirectly1 from any health insurance issuer in connection with the enrollment of any individuals under this section4 7#c7 ,priority ,in awarding grants under this subsection1 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 market4 7#d7 ,funding ,for purposes of carrying out this subsection1 there is appropriated to the ,secretary1 out of any moneys in the ,treasury not otherwise appropriated1 such sums as are necessary for fiscal year #bjbd and for each subsequent fiscal year4 7m7 ,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 7n7 ,consultation ,in promulgating regulations to implement this section1 the ,secretary shall consult with interested parties1 including groups representing beneficiaries1 health care providers1 employers1 insurance companies1 and organizations representing first responders4 4