Sponsor
The bill expands coverage options and affordability supports (premium tax credits, Medicare buy‑in, reinsurance, Part D negotiation) that could lower costs and increase access for many, but does so at the cost of sizable new federal commitments, potential market distortions, administrative complexity, and uneven impacts on unsubsidized consumers.
People with incomes above current marketplace subsidy limits (including many middle‑class households) would become eligible for premium tax credits or see lower applicable percentages, reducing net premiums and likely increasing insurance uptake.
Adults aged 50–64 would be able to buy into Medicare A/B/D with premium assistance, cost‑sharing protections comparable to Exchange silver plans, and a community‑rated supplemental option, expanding access and lowering out‑of‑pocket costs for near‑elderly and disabled adults.
State reinsurance programs and extended market risk‑protection (reinsurance and risk‑corridor mechanisms) reduce insurer risk for high‑cost enrollees, improve plan availability, and can slow premium growth in individual markets.
Expanding premium tax credits, broadening Medicare benefits, creating a Medicare buy‑in, funding reinsurance/risk programs, and related demonstrations would substantially raise federal spending and could increase the deficit or require offsets.
Unsubsidized or ineligible consumers (especially middle‑income households) could face higher premiums if subsidies change risk pools or insurers pass on program fees, limiting benefits for those not receiving assistance.
Buy‑in and supplemental options may carry high premiums (and steep late‑enrollment surcharges), making coverage unaffordable for some 50–64‑year‑olds despite the option to enroll.
Based on analysis of 10 sections of legislative text.
Expands ACA premium tax credits, creates a Medicare buy‑in for ages 50–64, establishes a federal direct Medicare supplemental option, authorizes Part D price negotiations, and funds individual‑market reinsurance.
Representative · D-IL
Official title: To amend title XVIII of the Social Security Act to provide for an option for individuals who are ages 50 to 64 to buy into Medicare, to provide for health insurance market stabilization, and for other purposes.
Introduced March 12, 2026 by S. Raja Krishnamoorthi · Last progress March 12, 2026
Expands federal health coverage and lowers consumer costs by (1) removing the 400% FPL cap on ACA premium tax credit eligibility and creating a new sliding applicable-percentage table; (2) creating a voluntary Medicare buy-in for adults ages 50–64 and allowing those buy‑in enrollees to access Parts A/B/D benefits and MA–PD plans; (3) creating a federal direct Medicare supplemental insurance option to cover most cost‑sharing for traditional Part B enrollees; (4) authorizing HHS to negotiate Part D drug prices with plan sponsors/MA–PD organizations; and (5) establishing a federal individual‑market reinsurance fund, reauthorizing risk corridors, expanding CMMI authority to include buy‑in enrollees, and repealing a prior reconciliation subtitle. Many provisions change tax and benefit rules and set new premium‑setting, trust fund, and reporting authorities for HHS and Treasury, with staged effective dates beginning in 2026–2029 for key items.