Workers ages 50 to 64 would gain a new option to buy into Medicare under a new Social Security Act section 1899D, with premiums set by CMS, financial help tied to ACA cost-sharing rules, and grants to states and nonprofits for outreach. The bill mandates that HHS negotiate Part D prescription drug prices starting in plan year 2029 by repealing the longstanding noninterference clause that has blocked direct negotiation with manufacturers. It makes ACA premium tax credits (PTC, the subsidy that lowers marketplace premiums) permanent above 400% of the federal poverty line (FPL, the income threshold used for benefits) with a sliding 0% to 8.5% income cap on premiums starting in tax year 2027. A new Medicare Direct Supplemental Insurance program (a public alternative to Medigap, the private add-on coverage that pays Medicare's out-of-pocket costs) would cover deductibles and copays after a $100 annual deductible, beginning January 2027, and Medigap insurers would have to accept new Buy-In enrollees during a 30-day window. The bill also revives ACA risk corridors (a profit-and-loss sharing pool) for insurers in 2028 through 2031 and creates a federal reinsurance fund to backstop high-cost individual-market enrollees. Section 9 fully repeals Subtitle B of Title VII of Public Law 119-21, the 2025 reconciliation package's health provisions, including the Medicaid work-and-community-engagement requirement for the expansion population. Affected groups include workers ages 50-64, current Medicare beneficiaries, ACA marketplace enrollees above 400% FPL, Medicaid expansion enrollees, drug manufacturers, and Medigap and individual-market insurers.
Average Household Impact
- Medicare Buy-In opens to ages 50-64 — new public coverage option below age 65
- ACA premium tax credits made permanent above 400% FPL — caps premiums at 8.5% of income
- New Medicare supplemental plan with $100 deductible — covers Part A/B cost-sharing from 2027
- Medigap 30-day guaranteed-issue window for Buy-In enrollees — protects access regardless of health
- Medicaid work-and-community-engagement requirement repealed — restores coverage for expansion enrollees
- HHS-negotiated Part D drug prices begin 2029 — lowers what seniors pay at the pharmacy
- Federal reinsurance fund for high-cost marketplace enrollees — reduces individual-market premium pressure
Corporate Benefits
- Drug manufacturers face mandatory Part D price negotiation — ends the noninterference shield
- Insurers get ACA risk corridors restored for 2028-2031 — federal backstop on Exchange gains/losses
- Individual-market insurers gain federal reinsurance for high-cost enrollees — offloads catastrophic claims
Transparency & Accountability
- Congress mandates HHS drug-price negotiation — reasserts oversight after two-decade noninterference ban
Congressional Summary
Medicare Expansion and Lowering Costs Now ActThis bill establishes a Medicare buy-in option for certain qualifying individuals and makes a series of other changes relating to health care costs. It also repeals the health provisions that were enacted under what is commonly known as the One Big Beautiful Bill Act.Specifically, the bill allows individuals aged 50 to 64 to enroll in Medicare if such individuals would otherwise qualify for Medicare at the age of 65. The Centers for Medicare & Medicaid Services (CMS) must determine enrollment periods and set premiums for the buy-in option established under the bill, in accordance with specified requirements. The CMS must also award grants to states and nonprofit organizations for outreach and enrollment activities relating to the buy-in option.Additionally, the bill repeals the health provisions that were enacted under what is commonly known as the One Big Beautiful Bill Act. Among other provisions, the act required individuals who are eligible for Medicaid as part of the Medicaid expansion population to engage in community service, work, or other activities in order to qualify for Medicaid. (For more information about these and other health provisions in the act, see CRS Report R48633.)The bill also (1) establishes a supplemental option under Medicare to cover cost-sharing for beneficiaries; (2) establishes an individual market reinsurance program relating to coverage of high-cost individuals, as specified; and (3) expands eligibility for the premium tax credit.
Details
- Congress
- 119th
- Chamber
- House
- Status
- summarized
- Action
- Introduced in House
- Action Date
- 2026-03-12
- Date Added
- 2026-05-05
- Source
- Congress.gov →
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