H.R. 6147

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6147 Introduced in House (IH)]

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119th CONGRESS
1st Session
H. R. 6147

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

November 19, 2025

Mr. Landsman introduced the following bill; which was 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. 1899D. (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, 2027, and ends on December 31, 2029, 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 2026 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.''.
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