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Creates a new Medicare “buy‑in” that lets qualified first responders aged 50–64 who left service because of retirement or disability enroll in Medicare Parts A, B, and D (and comparable Part C MA–PD coverage). The Secretary of HHS sets premiums based on estimated per‑person Medicare costs, oversees enrollment periods coordinated with Exchanges and Medicare Parts C/D, and must implement protections (guaranteed issue/Medigap rules), an oversight board, and outreach grants to boost enrollment. The law treats the coverage as minimum essential coverage for tax purposes, preserves employer premium exclusion treatment, prevents states from moving Medicaid beneficiaries ages 50–64 into this buy‑in (with a narrow exception), and requires HHS to ensure the program does not reduce benefits for traditional Medicare or harm Medicare trust funds. Initial coverage begins on January 1 of the first year at least one year after enactment; outreach grants run 2027–2029 and ongoing Treasury funds are authorized for outreach starting 2026.
The bill expands access to near‑Medicare coverage and supplemental protections for qualified first responders under 65, but does so with fiscal and policy trade‑offs that can raise costs for low‑income people, limit state flexibility, and increase federal budget exposure while preserving tax preferences.
Qualified first responders ages 50–64 can enroll in Medicare-equivalent Parts A, B, and D before age 65, lowering out-of-pocket medical costs and expanding access to near-Medicare coverage for that group.
Enrollees keep guaranteed-issue Medigap protections at initial and subsequent enrollments, improving access to supplemental coverage without underwriting barriers for those who buy in.
Premiums are actuarially set to cover projected Parts A, B, and D costs and administrative expenses, making pricing more transparent and actuarially fair to enrollees and reducing likelihood of hidden cross-subsidies.
People who enroll in the buy-in are not eligible for Medicaid cost‑sharing assistance, which could increase out-of-pocket costs for low-income individuals who would otherwise receive that help.
States are barred from enrolling Medicaid beneficiaries aged 50–64 into the buy-in, limiting state flexibility to use the buy-in to reduce costs or coordinate coverage for low‑income and dual‑eligible populations.
Premiums paid into Medicare trust funds could increase federal fiscal exposure if enrollment or cost estimates are inaccurate, creating potential downside risk to taxpayers despite statutory safeguards.
Introduced November 19, 2025 by Ruben Gallego · Last progress November 19, 2025