HR6147-119

What This Bill Does

The Expanding Health Care Options for First Responders Act creates a new Medicare buy-in pathway for qualified first responders who are at least 50 but under 65, live in the United States, are U.S. citizens, nationals, or lawful permanent residents, are not otherwise eligible for Medicare Parts A or B, and separated from service due to retirement or disability. Covered first responders include qualified law enforcement officers, certain public safety employees, and federal firefighters. Enrollees receive the same Medicare benefits and protections as people entitled to Part A and enrolled in Parts B and D, including Medicare Advantage prescription drug plans. HHS must coordinate enrollment and coverage periods with ACA exchanges and Medicare Parts C and D and set coverage to begin on January 1 of the first year at least one year after enactment. Premiums equal estimated average annual per-capita benefits and administrative expenses for Medicare coverage, divided monthly, and are deposited into Medicare trust funds. The bill treats the coverage as minimum essential coverage and as qualified health plan coverage for most premium tax credit purposes, bars States from buying Medicaid beneficiaries ages 50 to 64 into the option, permits employers to reimburse retiree premiums tax-free, applies Medigap guaranteed issue rules by substituting age 50 for age 65, and authorizes State and nonprofit outreach and enrollment grants.

Who Benefits and How

Retired first responders ages 50 to 64 benefit from a Medicare coverage option before age 65. Disabled first responders ages 50 to 64 benefit from access to Medicare benefits, Medicare Advantage, and prescription drug coverage. Former law enforcement officers, public safety employees, and federal firefighters benefit from a coverage pathway tailored to service separation. Employers of retired first responders benefit because they may reimburse premiums without creating taxable income. States and nonprofit organizations benefit from potential outreach and enrollment grants.

Who Bears the Burden and How

Eligible first responders must pay monthly premiums equal to estimated Medicare benefit and administrative costs. HHS and CMS must build enrollment periods, premium calculations, trust fund deposits, Medigap coordination, and outreach grants. States may not use the option to buy Medicaid beneficiaries ages 50 to 64 into Medicare. Medicare trust fund administrators must receive and allocate premium deposits. Medigap issuers must apply guaranteed issue protections for eligible buy-in enrollees beginning at age 50.

Key Provisions

• Creates a Medicare buy-in for retired or disabled first responders ages 50 through 64.
• Requires premiums based on estimated Medicare benefits and administrative expenses.
• Coordinates enrollment with ACA exchanges and Medicare Parts C and D.
• Preserves employer premium reimbursement and premium tax credit treatment.
• Bars States from buying Medicaid beneficiaries into the option.
• Authorizes outreach and enrollment grants for States and nonprofit organizations.