Medicare for All Act - Detailed breakdown

Existing federal sanctions for fraud and abuse under the Social Security Act, including individual exclusion, civil monetary penalties, and criminal penalties, will apply to the Medicare for All Program.

The Secretary of Health and Human Services is tasked with developing all policies, procedures, and regulations for the program, including eligibility, benefits, provider standards, and payment methods.

The Secretary will establish regional offices to manage the program locally, conduct annual health needs assessments, recommend payment changes, and establish quality assurance mechanisms.

The Secretary will establish an annual national health budget for all expenditures under the program, including operating costs, capital expenditures, special projects, and a reserve fund for emergencies.

Creates the Medicare for All Trust Fund in the U.S. Treasury, funded by new tax revenues and appropriations from existing federal health programs like Medicare and Medicaid.

Establishes a national health insurance program to provide comprehensive health coverage to all residents of the United States.

Entitles every U.S. resident to health benefits and allows them to obtain care from any qualified, participating provider.

Prohibits discrimination based on race, color, national origin, age, disability, sex, gender identity, sexual orientation, or pregnancy, and allows individuals to sue for violations.

Makes benefits available for individuals under 19 starting the first year after enactment, with benefits for all other eligible residents beginning in the fourth year.

Makes it unlawful for private insurers to sell, or employers to provide, health coverage that duplicates the benefits offered under the Medicare for All Program.

Covers a wide range of services, including hospital care, prescription drugs, mental health, dental, vision, reproductive care, and long-term home and community-based care.

Prohibits deductibles, coinsurance, and copayments for all covered benefits, with a potential annual cap of $200 for prescription drugs for some individuals.

Amends the Social Security Act to continue Medicaid coverage for institutional long-term care services not covered by the new program, with a state maintenance of effort requirement.

Prohibits retaliation against any employee who reports violations, refuses to engage in unlawful practices, or testifies in proceedings related to the Act.

A Beneficiary Ombudsman will be appointed to receive complaints, grievances, and requests for information from individuals enrolled in the Medicare for All Program and provide assistance.

Requires the evaluation and implementation of data collection on health disparities based on race, ethnicity, language, age, disability, sex, geography, or socioeconomic status.

Institutional providers like hospitals will be paid via negotiated global budgets, while individual practitioners will be paid through a national fee-for-service schedule.

The Secretary will annually negotiate the prices for pharmaceutical products, medical supplies, and medically necessary assistive equipment, and will establish a national prescription drug formulary.

Establishes an Office of Health Equity within the Department of Health and Human Services to coordinate programs, monitor data on disparities, and promote policies that enhance health equity.

Creates an Office of Primary Health Care within the Office of Health Equity to increase access to primary care, particularly for underserved populations, and set national health goals.

Amends ERISA to prohibit employee benefit plans from offering benefits that duplicate coverage provided under the Medicare for All Program and requires workers' compensation carriers to reimburse the program.

Terminates benefits under Medicare, Medicaid, and CHIP once Medicare for All benefits are available, with exceptions for long-term care. Also ends FEHBP benefits for eligible individuals.

Terminates the Federal and State Exchanges established under the Patient Protection and Affordable Care Act once Medicare for All benefits become available.

Amends the Social Security Act to cap annual out-of-pocket cost-sharing for Medicare beneficiaries at $1,500 and eliminates Part A and Part B deductibles.

Reduces the annual out-of-pocket threshold for Medicare Part D prescription drug plans to $300 during a transitional period.

Amends the Social Security Act to expand Medicare Part B coverage to include dental services, vision services, and hearing aids and examinations.

Removes the 24-month waiting period for Medicare coverage for individuals who qualify based on disability.

Establishes a temporary Medicare buy-in option, lowering the eligibility age in stages: to 55 in the first year, 45 in the second, and 35 in the third year after enactment.

Creates a public health plan, the Medicare Transition plan, offered through the Exchanges to provide affordable, high-quality health coverage throughout the United States during a transition period.

Sets reimbursement rates for health care providers under the Medicare Transition plan to be equivalent to Medicare fee-for-service rates and requires negotiated rates for prescription drugs.

Amends tax law to provide premium assistance tax credits and cost-sharing subsidies for individuals enrolled in the Medicare Transition plan, with special rules for residents of non-Medicaid expansion states.

Requires the Secretary to protect individuals from disruptions in care during the transition period and consult with patient advocacy organizations to ensure safety and continuity of care.

For up to 5 years, at least 1% of the national health budget will be allocated to provide assistance, such as wage replacement and job training, to workers dislocated by the implementation of this Act.

Increases the resource limits for SSI eligibility to $4,100 for an individual and $6,200 for a couple, effective January 1, 2025, with subsequent annual cost-of-living adjustments.