Medicare Expansion and Lowering Costs Now Act

Key Points

• People aged 50 to 64 could buy into Medicare, giving older adults who are not yet 65 a new health insurance option. Coverage would begin on January 1 of the first year starting at least one year after the bill becomes law. Enrollees would get the same Part A, B, and D benefits as current Medicare members, including the ability to join Medicare Advantage plans.
• Lower-income people who buy into Medicare early would get financial help similar to what the ACA marketplace offers. The government would transfer funds equal to 100% of the premium tax credits and cost-sharing reductions those individuals would have received on an Exchange plan, with a special focus on people earning below 200% of the poverty line.
• The bill requires the government to directly negotiate prescription drug prices with pharmaceutical companies for all Medicare Part D drugs, starting in 2029. This replaces the current law that blocked Medicare from negotiating. Drug makers could still offer even deeper discounts beyond the negotiated price.
• A new government-run supplemental insurance plan would launch in January 2028 to cover deductibles, copays, and other out-of-pocket costs that regular Medicare does not pay. This plan cannot deny anyone for pre-existing conditions and charges a community-rated premium that does not vary by age or location.
• The bill removes the income cap on premium tax credits for ACA marketplace plans starting in 2027, meaning people earning over 400% of the poverty line could qualify for help paying insurance premiums for the first time. It also creates a reinsurance fund to help insurers cover high-cost claims, which is designed to stabilize individual market premiums.
• The bill repeals health-related provisions from Public Law 119-21, a reconciliation law. It also allocates $500 million per year from 2026 through 2028 for outreach and enrollment grants to help people learn about and sign up for the Medicare buy-in option.