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HR7909119th CongressWALLET

Medicare Expansion and Lowering Costs Now Act

Sponsored By: Representative Krishnamoorthi, Raja [D-IL-8]

Introduced

Summary

This bill would create a new Medicare Buy‑In so that people aged 50–64 can buy Medicare Parts A, B, and D. It also would add a federal direct supplemental plan to cover cost‑sharing and give the Secretary limited authority to negotiate Part D drug prices.

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  • Would let people aged 50–64 buy Medicare Parts A, B, and D with the same benefits and access to Medicare Advantage and Medigap. It would exclude Medicaid beneficiaries in that age group and set premiums using a national per‑capita formula that could be adjusted for age or geography.
  • Would require the National Association of Insurance Commissioners to revise Medigap rules to ensure Buy‑In enrollees can get supplemental coverage during the 30‑day post‑enrollment window and during transition periods.
  • Would establish a Direct Medicare Supplemental Insurance program to cover deductibles and copays with a $100 annual deductible. Initial enrollment would open late 2027 with benefits effective January 1, 2028.
  • Would let the Secretary negotiate prices and discounts for Part D drugs for plans, with negotiations first applying to plan years beginning January 1, 2029, and semiannual reports to Congress starting June 1, 2029.
  • Would fund outreach and enrollment grants of $500 million per year for each of 2026, 2027, and 2028 and create an Oversight Board to monitor implementation.

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Bill Overview

Analyzed Economic Effects

6 provisions identified: 3 benefits, 0 costs, 3 mixed.

Medicare Buy-In for 50 to 64

If enacted, people aged 50 through 64 who are not already entitled to Medicare Part A could choose a voluntary Medicare Buy-In. Coverage would start on January 1 of the first year at least one year after enactment. The Secretary would set an annual premium each September; your monthly premium would be one‑twelfth of that annual amount. The law would create a Buy‑In Trust Fund and transfer amounts equal to 100% of any premium tax credit and 100% of any cost‑sharing reductions you would have gotten in an Exchange to lower Buy‑In premiums and cost‑sharing. Medicaid beneficiaries aged 50–64 would generally be excluded from buying in.

Expand premium tax credits nationwide

If enacted, the bill would remove the 400% of poverty limit for premium tax credits and set a new sliding scale of required premium shares by income. The table sets 0% up to 150% FPL, 0–2% for 150–200%, 2–4% for 200–250%, 4–6% for 250–300%, 6–8.5% for 300–400%, and 8.5% for incomes above 400%. The change would apply to tax years beginning after December 31, 2026 and can lower the net premium you pay for Exchange coverage.

Medicare Part D Price Negotiations

If enacted, the Secretary could negotiate prices, discounts, and rebates with drug manufacturers for medicines covered under Medicare Part D. The change would apply to plan years that begin January 1, 2029. The Secretary could not force a specific drug list, and plans could still obtain discounts below the negotiated price. The Secretary must report to Congress every six months starting June 1, 2029 about negotiations and achieved prices.

New Federal Medicare Supplemental Plan

If enacted, the bill would create a voluntary federal supplemental plan that pays Medicare Part A and B cost‑sharing after a $100 annual deductible. Initial enrollment would occur in the last quarter of 2027 for coverage effective January 1, 2028. Premiums would be community‑rated and set each September. Late enrollment raises your monthly premium by 10% for each full year you were not enrolled, up to 100% total. Premiums would be collected by the Secretary and held in a Treasury account to pay benefits and administration.

Undo recent health subtitle changes

If enacted, the bill would repeal Subtitle B of title VII of Public Law 119‑21. Laws and rules that relied on that subtitle would be treated as if the subtitle had not passed. The final effects would depend on the rules that were changed by that subtitle.

Stabilize individual market insurance costs

If enacted, the bill would create a federal reinsurance program that pays 80% of high claims above an attachment point up to a cap. The attachment point is $50,000 for plan years 2026–2028 and $100,000 for other years. The cap is $450,000 for 2026–2028 and $400,000 for other years (indexed after 2026). Reinsurance payments begin for plan years starting 2025 and the Fund would hold fees collected from participating plans. The bill also extends the ACA risk corridor authority through calendar years 2028–2031. The Fund and fees could lower insurer risk but participating plans pay fees that could affect premiums.

Sponsors & CoSponsors

Sponsor

Krishnamoorthi, Raja [D-IL-8]

IL • D

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

No roll call votes available for this bill.

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