Sponsor
S. Raja Krishnamoorthi
Representative · D-IL
Representative · D-IL
The bill expands subsidy eligibility and creates a Medicare buy‑in and stabilization programs that can increase coverage and lower costs for many older adults and marketplace enrollees, but does so at the cost of materially higher federal spending, greater market and administrative complexity, and the risk that some consumers or insurers will face higher premiums or narrower drug access.
Adults aged 50–64 (and near‑65 individuals) and current Medicare beneficiaries gain access to comprehensive Medicare coverage (Parts A/B/D), a standardized community‑rated supplemental option, reduced cost‑sharing (including coverage of some deductibles/copays), premium assistance comparable to Exchange silver plans, outreach/enrollment grants, and recurring enrollment opportunities—increasing pre
Low‑ and moderate‑income and many middle‑class households above 400% FPL become eligible for premium tax credits via a new sliding scale, lowering their net marketplace premiums and improving affordability for people previously ineligible.
People in the individual insurance market (especially older or sicker enrollees) and state markets may see more stable premiums and improved plan availability because a reinsurance fund plus extended risk‑corridor mechanisms reduce insurer risk and encourage issuer participation.
Taxpayers face materially higher federal spending and potential increases in deficits or pressure for tax offsets because the bill expands premium tax credits, broadens Medicare benefits, establishes a buy‑in program, and funds reinsurance/risk adjustment mechanisms.
Some consumers—including unsubsidized marketplace enrollees, certain 50–64 adults, and Medicare participants—could face higher premiums, late‑enrollment surcharges, or greater out‑of‑pocket costs if buy‑in premiums are set to fully fund benefits or if program fees are passed through to enrollees.
Private insurance markets and employer coverage risk being distorted—through crowding‑out by buy‑in options, fee or administrative burdens that disadvantage small insurers, and extensions (e.g., risk corridors) that may reduce pricing discipline—hurting competition and potentially long‑term market stability.
Based on analysis of 10 sections of legislative text.
Creates a Medicare buy‑in for ages 50–64, a federal Medicare supplemental plan, removes the 400% FPL ACA subsidy cap, authorizes Part D negotiation, and funds reinsurance and risk corridors.
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
Creates a federal Medicare buy‑in option for adults ages 50–64, establishes a new federal Medicare supplemental plan, removes the 400% FPL cap on Affordable Care Act premium tax credits and redesigns the applicable percentage structure, directs HHS to negotiate Part D drug prices, and creates federal reinsurance and reauthorized risk‑corridor authorities to stabilize individual market premiums. The bill also expands Center for Medicare and Medicaid Innovation (CMI) authority to include buy‑in enrollees and repeals a prior reconciliation subtitle. The bill sets premium frameworks, new trust accounts, and administrative rules for the buy‑in and supplemental products; phases in coverage on specified timelines (with several provisions effective in 2027–2029); and requires reporting, data collection, and formulaic payment rules for reinsurance and drug price negotiations. It changes tax law for premium tax credit eligibility beginning with taxable years after 2026.