Medicare Expansion and Lowering Costs Now Act
Summary
What This Bill Does
The Medicare Expansion and Lowering Costs Now Act creates several coverage and cost-reduction programs. It adds a Medicare buy-in option for people ages 50 to 64 who are not otherwise eligible for Medicare but would be eligible if they were 65. Buy-in enrollees receive Medicare Parts A, B, and D benefits and protections, including Medicare Advantage with prescription drug coverage, pay premiums calculated by the Secretary, and may receive financial assistance similar to Affordable Care Act premium tax credits and cost-sharing reductions. The bill creates a Medicare Buy-In Trust Fund, an oversight board, enrollment grants for outreach and assistance, and ACA integration rules.
The bill also creates a direct Medicare supplemental insurance option for people with traditional Medicare Parts A and B who are not enrolled in Medicare Advantage. The supplemental option pays deductibles, copayments, and other cost-sharing above a $100 annual deductible, uses community-rated premiums, bars pre-existing condition underwriting, permits late-enrollment penalties, and creates a Direct Medicare Supplemental Insurance Account.
The bill replaces Medicare Part D noninterference language with a requirement that the Secretary negotiate covered Part D drug prices with pharmaceutical manufacturers and report every six months to Congress on negotiated prices and discounts. It creates an Individual Market Reinsurance Fund for high-cost qualified health plan enrollees, authorizes plan fees, and requires reinsurance payments to issuers. It authorizes CMMI to include Medicare buy-in enrollees in demonstrations. It also expands premium tax credits by removing the 400 percent of poverty cap and setting a sliding scale that reaches 8.5 percent of income for households at 400 percent of poverty and above.
Who Benefits and How
Adults ages 50 to 64 without Medicare access benefit from a new public coverage option with Medicare benefits and ACA-style financial assistance. Traditional Medicare beneficiaries benefit from a direct supplemental option that pays cost sharing without pre-existing-condition underwriting. Medicare Part D beneficiaries benefit if federal negotiation lowers prescription drug prices. Individual-market enrollees benefit if reinsurance reduces premiums or stabilizes plans. Households above 400 percent of the poverty line benefit because the premium tax credit cap is removed and their contribution is limited by the new sliding scale.
Who Bears the Burden and How
CMS must build and administer the buy-in, supplemental insurance, drug negotiation, reinsurance, CMMI integration, enrollment outreach, premium collection, trust fund, and oversight systems. Pharmaceutical manufacturers bear revenue pressure from federal negotiation of Part D prices. Qualified health plans must pay reinsurance fees and coordinate with the reinsurance program. Federal premium tax credit and cost-sharing accounts bear higher costs from expanded assistance, and Medicare administrative contractors may need to coordinate supplemental insurance payments.
Key Provisions
- Creates a Medicare buy-in option for adults ages 50 to 64 who would qualify for Medicare but for age.
- Establishes Medicare buy-in premiums, a Medicare Buy-In Trust Fund, ACA-style financial assistance, oversight, exchange integration, and enrollment grants.
- Creates a direct Medicare supplemental insurance option for traditional Medicare beneficiaries with a $100 annual deductible and community-rated premiums.
- Requires the Secretary to negotiate covered Part D drug prices with pharmaceutical manufacturers and report semiannually to Congress.
- Establishes an Individual Market Reinsurance Fund and reinsurance payments for high-cost qualified health plan enrollees.
- Authorizes CMMI demonstrations to include Medicare buy-in enrollees.
- Expands premium tax credits by removing the 400 percent income cap and revising the sliding-scale applicable percentages.
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers with clause-level evidence links.
At a Glance
What This Bill Does
Expands health coverage and lowers consumer costs by creating a Medicare buy-in for adults ages 50 to 64, creating a direct Medicare supplemental insurance option, requiring Medicare Part D drug price negotiation, establishing an individual-market reinsurance fund, allowing CMMI demonstrations for buy-in enrollees, and expanding premium tax credits.
Key Policy Areas
Medicare, Prescription Drugs, Health Insurance Marketplaces, Premium Tax Credits, Reinsurance
Primary Purpose
Expands health coverage and lowers consumer costs by creating a Medicare buy-in for adults ages 50 to 64, creating a direct Medicare supplemental insurance option, requiring Medicare Part D drug price negotiation, establishing an individual-market reinsurance fund, allowing CMMI demonstrations for buy-in enrollees, and expanding premium tax credits.
Policy Domains
Section 3 Medicare buy-in option for adults ages 50 to 64
Identified Gains
- Adults ages 50 to 64 without Medicare eligibility
- Low-income Medicare buy-in enrollees
- Exchange enrollment assistance organizations
Identified Costs
- CMS Medicare buy-in administrators
- Medicare Buy-In Trust Fund administrators
- State Medicaid programs
- CMS Chief Actuary
Section 4 direct Medicare supplemental insurance option
Identified Gains
- Traditional Medicare beneficiaries
- Medicare beneficiaries with high cost sharing
- Medicare supplemental payment contractors
Identified Costs
- CMS supplemental insurance administrators
- Private Medigap insurers
- Direct Medicare Supplemental Insurance Account administrators
Sections 5, 6, 8, and 10 drug negotiation, reinsurance, CMMI, and premium tax credits
Identified Gains
- Medicare Part D beneficiaries
- Qualified health plan issuers receiving reinsurance
- High-cost individual-market enrollees
- Exchange households above 400 percent of poverty
Identified Costs
- Pharmaceutical manufacturers of Part D drugs
- CMS drug price negotiation staff
- Qualified health plans paying reinsurance fees
- Federal premium tax credit accounts
- Internal Revenue Service premium tax credit administrators
Legislative Progress
In CommitteeReferred to the Committee on Energy and Commerce, and in …
Introduced in House
Mr. Krishnamoorthi introduced the following bill; which was referred to …
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
CMS Chief Actuary, CMS Medicare buy-in administrators, CMS drug price negotiation staff
Positive-direction: CMS Chief Actuary, Federal premium tax credit accounts, Individual Market Reinsurance Fund, Internal Revenue Service premium tax credit administrators, Medicare Buy-In Oversight Board
Negative-direction: CMS Medicare buy-in administrators, CMS drug price negotiation staff, CMS reinsurance program administrators, CMS supplemental insurance administrators, Center for Medicare and Medicaid Innovation staff, Direct Medicare Supplemental Insurance Account administrators, Medicare Buy-In Trust Fund administrators
Adults ages 50 to 64 without Medicare eligibility, Exchange enrollment assistance organizations, Exchange households above 400 percent of poverty
Positive-direction: Adults ages 50 to 64 without Medicare eligibility, Exchange enrollment assistance organizations, Exchange households above 400 percent of poverty, Health insurance marketplaces, High-cost individual-market enrollees, Low-income Medicare buy-in enrollees, Low-income exchange enrollees, Qualified health plan issuers receiving reinsurance
Negative-direction: Qualified health plans paying reinsurance fees
Medicare Part D beneficiaries, Medicare beneficiaries with high cost sharing, Medicare buy-in enrollees ages 50 to 64
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
- "exchange"
- → Affordable Care Act health insurance Exchange
- "secretary"
- → Secretary of Health and Human Services
- "eligible_individual"
- → Individual age 50 to 64 who would be eligible for Medicare but for age
- "secretary"
- → Secretary of Health and Human Services
- "qualified_entity"
- → Fiscal intermediary, carrier, or other qualified entity arranging payment coordination
- "eligible_beneficiary"
- → Traditional Medicare beneficiary enrolled in Parts A and B and not Medicare Advantage
- "issuer"
- → Qualified health plan issuer
- "taxpayer"
- → Premium tax credit taxpayer
- "secretary"
- → Secretary of Health and Human Services
- "manufacturer"
- → Pharmaceutical manufacturer of covered Part D drugs
Key Definitions
Terms defined in this bill
A fund administered by the Secretary to finance state-compliant individual-market stabilization reinsurance programs.
Payment of Medicare deductibles, copayments, and other cost-sharing amounts, subject to a $100 annual deductible.
An individual age 50 to 64 who is not otherwise entitled to Medicare but would be eligible for Medicare if age 65.
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology