Medicare Expansion and Lowering Costs Now Act

Lets workers 50-64 buy into Medicare, forces Medicare to negotiate Part D drug prices from 2029, and makes ACA subsidies permanent above 400% of poverty.

The details

Workers ages 50 to 64 would get a new option to buy into Medicare, under a new Social Security Act section 1899D. CMS would set the premiums. Financial help would be tied to ACA cost-sharing rules, and grants would fund outreach by states and nonprofits. The bill also requires HHS to negotiate Part D prescription drug prices starting in plan year 2029. This repeals the longstanding noninterference clause that has blocked direct negotiation with drug manufacturers. ACA premium tax credits (PTC, the subsidy that lowers marketplace premiums) would become permanent for people earning above 400% of the federal poverty line (FPL). FPL is the income threshold used to determine benefit eligibility. Starting in tax year 2027, a sliding scale would cap premiums at 0% to 8.5% of income. A new Medicare Direct Supplemental Insurance program would begin in January 2027. It's a public alternative to Medigap, the private add-on coverage that pays Medicare's out-of-pocket costs. It would cover deductibles and copays after a $100 annual deductible. 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 — from 2028 through 2031. It also 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. That includes the Medicaid work-and-community-engagement requirement for the expansion population. Affected groups include workers ages 50-64, current Medicare beneficiaries, and ACA marketplace enrollees above 400% FPL. Also affected: Medicaid expansion enrollees, drug manufacturers, and Medigap and individual-market insurers.