Early-Onset Alzheimer’s Coverage Act of 2026
- Sponsor
- Rep. Davids, Sharice [D-KS-3]
- Committees
- Energy and Commerce Committee (primary)
- Last action
- Oct 5, 2026
Bottom line
The bill expands Medicare eligibility to individuals with early-onset Alzheimer's disease, allowing them to access comprehensive health coverage before age 65 by paying premiums.
What it actually does
This bill establishes a Medicare buy-in option for individuals diagnosed with early-onset Alzheimer's disease who are under 65 but would otherwise be eligible for Medicare based on age. It grants these individuals full Medicare Part A, B, and D benefits, including access to Medicare Advantage plans and guaranteed access to Medigap supplemental policies, provided they pay the applicable premiums.
Proponents argue
Supporters argue this bill addresses a critical coverage gap for individuals diagnosed with early-onset Alzheimer's, who often face significant healthcare costs and may lose employment before qualifying for Medicare due to age. It provides essential access to comprehensive care, including prescription drugs and supplemental insurance, alleviating financial burdens on affected individuals and their families.
Opponents contend
Opponents might contend that expanding Medicare eligibility to a new population group, even with premium payments, could increase overall Medicare expenditures and administrative complexity, potentially straining the program's long-term solvency. Concerns could also be raised about the precedent set for other disease-specific buy-in options and the definition of 'early-onset Alzheimer's disease'.
The bill is relatively short and clearly written, making its core provisions accessible for an informed reader to understand within a reasonable timeframe.
Section 2(a), adding new section 1899D(a) to Title XVIII of the Social Security Act.
Medicare Buy-In Eligibility for Early-Onset Alzheimer's Disease
This provision establishes eligibility for individuals diagnosed with early-onset Alzheimer's disease to enroll in Medicare. To qualify, an individual must be diagnosed with early-onset Alzheimer's (as defined by the Commissioner of Social Security) and would otherwise be eligible for Medicare Part A or B if they were 65 years old.
Supporters argue
Supporters argue this provision is crucial for providing timely and comprehensive healthcare coverage to individuals facing a devastating diagnosis that often leads to premature loss of employment and high medical expenses. It ensures they receive necessary care without waiting until age 65.
Critics contend
Critics might argue that defining 'early-onset Alzheimer's' through the Program Operations Manual System could lead to inconsistent application or administrative challenges. There could also be concerns about the precedent of disease-specific eligibility expansions.
Tradeoffs
This provision balances the immediate healthcare needs and financial relief for a vulnerable population against potential increases in Medicare enrollment and associated costs, as well as the administrative complexities of managing a new eligibility pathway.
Section 2(a), adding new section 1899D(a)(3) to Title XVIII of the Social Security Act.
Full Medicare Benefits and Protections
Individuals who buy into Medicare under this section will receive the same benefits and protections as those entitled to Part A and enrolled in Parts B and D. This includes the ability to enroll in Medicare Advantage plans with prescription drug coverage (MA-PD plans) and access to the Medicare Beneficiary Ombudsman.
Section 2(a), adding new section 1899D(b) to Title XVIII of the Social Security Act.
Special Enrollment Periods
The Secretary must establish a 3-month enrollment period starting the first day of the month following an individual's early-onset Alzheimer's diagnosis. Special enrollment periods similar to those under Part B will also be provided. Coverage begins the first day of the month after enrollment.
Section 2(a), adding new section 1899D(c) to Title XVIII of the Social Security Act.
Premium Requirements for Buy-In Enrollees
Individuals enrolling under this buy-in option will be responsible for paying the same Part A, B, and D premiums as if they were 65 years old and not otherwise entitled to Part A benefits. This means they would pay the full Part A premium (if they haven't paid enough Medicare taxes), the standard Part B premium, and any applicable Part D premium.
Section 2(a), adding new section 1899D(e) to Title XVIII of the Social Security Act, and Section 2(b) amending Section 1882 of the Social Security Act.
Guaranteed Medigap Access
Individuals eligible for the Medicare buy-in will also be eligible for Medigap (Medicare supplemental policies) if they apply within six months of their Medicare enrollment. The Secretary must require Medigap issuers in each state to offer at least one policy to these individuals. The National Association of Insurance Commissioners (NAIC) will be requested to revise standards for Medigap policies to reflect these new requirements.
The bill defines 'early-onset Alzheimer's disease' by referencing the Commissioner of Social Security's Program Operations Manual System (POMS) or a successor document.
Section 2(a), adding new section 1899D(a)(2)(A) to Title XVIII of the Social Security Act.
Why it matters:This is a common legislative practice to avoid codifying highly technical or frequently updated definitions directly into statute, allowing for administrative flexibility. However, it means the precise scope of eligibility is determined by an external agency's manual rather than explicit statutory language.
Case for: Supporters would argue that relying on an existing administrative definition ensures consistency with current disability determinations for Alzheimer's and allows for flexibility to update the definition as medical understanding evolves without needing new legislation.
Case against: Critics might contend that delegating such a critical eligibility definition to an administrative manual reduces transparency and congressional oversight over who ultimately qualifies for this significant Medicare expansion. It could also lead to potential discrepancies if the POMS definition is not perfectly aligned with clinical diagnostic criteria.
Estimated impact: The exact number of eligible individuals will depend entirely on the precise definition of 'early-onset Alzheimer's disease' as articulated in the POMS. A broad definition could significantly increase enrollment, while a narrow one would limit it.