Fair Care Act of 2026

E Medicare with Choice and Competition

1 Opt-Out and auto-Enrollment

1860E–11. Part A opt-out and MA auto-enrollment

(a) Permitting individuals To opt out of part A coverage without losing social security benefits

(1) In general. The Secretary shall establish— The process under subparagraph (B) shall be coordinated with the enrollment process under section 1837 for part B.

(A) a process by which an individual otherwise entitled to benefits under part A may elect (at a time and in a manner specified under the process) to waive such entitlement; and

(B) a process by which an individual who elects to waive such entitlement may revoke (at a time and in a manner specified under the process) such waiver.

(2) Application of late enrollment penalty. An individual who revokes a waiver under paragraph (1)(B) shall be subject to a late enrollment penalty as applied under section 1860E–32(c)(2)(C).

(3) No impact on title II benefits. Notwithstanding any other provision of law, an election of an individual to waive entitlement to benefits under part A under paragraph (1)(A) shall not result in any loss of benefits under title II.

(4) Deemed opt-out

(A) An election of an individual to waive entitlement to benefits under part A under paragraph (1)(A) is also deemed the filing of a notice of termination of benefits under part B pursuant to section 1838(b)(1).

(B) The termination of benefits under part B pursuant to section 1838(b) is also deemed to be a waiver of any entitlement to benefits under part A.

(b) Special open enrollment period without late enrollment penalty for current part A only or part B only enrollees. Notwithstanding any other provision of law, in the case of an individual who as of the general effective date, is entitled to benefits under part A but not enrolled under part B, or who is enrolled under part B but not entitled to benefits (or enrolled) under part A, beginning as of such date, such individual shall be deemed to be enrolled under part B or part A, respectively, unless such individual elects to be enrolled (or entitled to benefits) under neither of such parts during a special open enrollment period specified by the Secretary. No increase in the monthly premium of an individual pursuant to section 1839(b) or section 1818(c) shall be effected in the case of any such individual who is deemed enrolled under part B or part A pursuant to the previous sentence with respect to any period prior to the date of such enrollment.

(c) Auto enrollment of dual eligible individuals under Medicare Advantage plans

(1) In general. Except in the case of a State that has elected the maintenance of effort option described in section 1944(b)(2), in the case of an individual described in subparagraph (A)(ii) of section 1935(c)(6) (taking into account the application of subparagraph (B) of such section), the Secretary shall establish a process for the enrollment in an MA–PD plan that is a managed care plan under part C that has a monthly beneficiary premium that does not exceed the premium assistance available under section 1860E–41(b)(1)(A). If there is more than one such plan available, the Secretary shall enroll such an individual on a random basis among all such plans in the PDP region.

(2) Right to disenroll. Nothing in paragraph (1) shall prevent such an individual from declining enrollment in any such plan (and thereby obtaining coverage under Medicare fee-for-service) or from changing enrollment in such a plan to another MA–PD plan.

1860E–12. Coordination with part D

(a) Deemed enrollment under part D

(1) In general. The Secretary shall establish a process that, beginning as of the general effective date, provides for the enrollment in a prescription drug plan that has a monthly base beneficiary premium that does not exceed the weighted average of premiums for such plans that provide standard prescription drug coverage (as defined in section 1860D–2(b)) with respect to the area involved (on a random basis among all such plans in the applicable PDP region) of each Medicare enrollee (as defined in section 1860E–51) who— Nothing in the previous sentence shall prevent such an individual from declining or changing such enrollment. Such process shall be carried out in the same manner as the process described in section 1860D–1(b)(1)(C).

(A) failed to enroll in such a prescription drug plan during the applicable enrollment or coverage election period under section 1860D–1(b); and

(B) failed to elect not to enroll in such a prescription drug plan during an applicable opt-out period described in paragraph (2).

(2) Opt-out periods. The process under paragraph (1) shall provide for the opportunity to make an election described in subparagraph (B) of such paragraph during an opt-out period that is coordinated with the relevant enrollment or coverage election period under section 1860D–1.

(3) Late enrollment penalties. In the case of an individual who makes an election described in paragraph (1)(B) and then enrolls in a prescription drug plan, the late enrollment penalty under section 1860D–13(b) shall apply to the monthly beneficiary premium of such individual, except that in applying such section, any reference to the initial enrollment period of such individual shall be deemed to be a reference to the opt-out period under paragraph (2) during which the individual elected not to enroll in a prescription drug plan.

(4) No late enrollment penalty for current fee-for-service beneficiaries without drug coverage. In the case of an individual who is a Medicare enrollee before the date of enactment of this section and who was not enrolled under a prescription drug plan before being enrolled under such a plan pursuant to paragraph (1), there shall be no increase in the base beneficiary premium of an individual under section 1860D–13 by a late enrollment penalty under subsection (b) of such section with respect to any period prior to the date of such enrollment.

(b) Reference to required prescription drug coverage under part C. For provision requiring coverage under MA plans to include prescription drug coverage, see section 1860E–26.

(ll) Limitation on benefits for full-Benefit dual eligible individuals. Effective as of the general effective date (as specified in section 1860E–62), except in the case of a State which has elected the option described in section 1944(b)(2), in the case of an individual described in subparagraph (A)(ii) of section 1935(c)(6) (taking into account the application of subparagraph (B) of such section), notwithstanding any other provision of law, medical assistance shall not be available under this title for any items and services for which payment may be made under title XVIII.

1944. Maintenance of effort options for full-benefit dual eligible individuals

(a) In general. Effective as of the general effective date (as specified in section 1860E–62), a State shall elect, in a form and manner specified by the Secretary, a maintenance of effort option described in subsection (b). In the case of a State that fails to make such an election, the State shall be deemed to have elected the option described in subsection (b)(3).

(b) Maintenance of effort options described. The following are maintenance of effort options described in this subsection for a State, which shall apply to all individuals described in subparagraph (A)(ii) of section 1935(c)(6) (taking into account the application of subparagraph (B) of such section) for such State:

(1) Enrollment of dual eligibles in comprehensive Medicaid managed care plan

(A) In general. The State enrolls all such individuals in a comprehensive Medicaid managed care plan offered by a managed care entity under section 1932.

(B) Payment of subsidy amount to State. In the case of a State that elects the option under this paragraph with respect to an individual, the Secretary established under section 1860E–51 shall pay to the State the same amount that the individual would be entitled to have paid as an income-related premium subsidy under section 1860E–41(b)(1)(A) plus the amount that the Secretary estimates would have been paid with respect to the individual under part D (including the actuarial value of subsidy payments under sections 1860D–13 and 1860D–14). Such payment shall be made in appropriate part from the Federal Hospital Insurance Trust Fund under section 1817 and the Federal Supplementary Medical Insurance Trust Fund under section 1841.

(C) Relation to part D rules. In the case of a State that has elected the option under this paragraph, notwithstanding any other provision of law—

(i) the coverage provided under this option shall be in lieu of any coverage that may otherwise be provided under part D; and

(ii) the payment to the State under subparagraph (B) shall be in lieu of any payments otherwise made with respect to such individual under such part.

(2) Other innovative alternatives

(A) In general. The State submits to the Secretary, and has approved by the Secretary, an innovative alternative proposal relating to coordinating coverage of such individuals under Medicare and the State plan under title XIX.

(B) Process for review. With respect to proposals submitted to the Secretary under subparagraph (A), the Secretary shall approve such a proposal if the State demonstrates with respect to the proposal that—

(i) there would be no increased cost to the Federal Government if it were approved; and

(ii) there would be no reduction in the quality of care provided to such individuals if the proposal were approved.