This legislation, titled the "Medicare Expansion and Lowering Costs Now Act," introduces a significant Medicare buy-in option for individuals aged 50 to 64. This option allows those not yet eligible for Medicare to enroll and receive the same comprehensive benefits as traditional Medicare beneficiaries, including Parts A, B, and D, and access to Medicare Advantage and Part D plans. Premiums for this buy-in will be actuarially determined, with potential adjustments for geographic factors and age, and will be deposited into a newly established Medicare Buy-In Trust Fund. Crucially, individuals enrolling in the Medicare buy-in option will receive financial assistance substantially similar to the premium tax credits and cost-sharing reductions available through the Affordable Care Act (ACA) Exchanges. The coverage will be treated as minimum essential coverage under the ACA and made available through the Exchanges. The bill also guarantees access to Medigap policies for these enrollees during specific periods and establishes an oversight board and grants for outreach and enrollment activities. To address prescription drug costs, the bill mandates the Secretary of Health and Human Services to negotiate lower prices for covered Part D drugs with pharmaceutical manufacturers. This provision aims to reduce drug expenses for Medicare beneficiaries, with the Secretary required to report semi-annually to Congress on negotiation outcomes and price reductions achieved. This negotiation authority will take effect for plan years beginning January 1, 2029. The legislation also focuses on stabilizing the individual health insurance market by establishing an Individual Market Reinsurance Fund . This fund will provide reinsurance payments to health insurance issuers for high-cost individuals enrolled in qualified health plans, covering a percentage of claims exceeding specified thresholds. The bill also reauthorizes the ACA's risk corridor program for calendar years 2028 through 2031, further supporting market stability. Furthermore, the bill significantly enhances the Affordable Care Act's premium tax credits . It removes the existing income cap, making more individuals eligible for subsidies, and revises the applicable percentages to increase the generosity of these credits. For instance, individuals with household incomes up to 150 percent of the poverty line will pay 0 percent of their income towards premiums, making health coverage more affordable for low-income populations. These changes to premium tax credits will apply to taxable years beginning after December 31, 2026. Finally, the bill introduces a Medicare Direct Supplemental Insurance Option , a new federal program offering a voluntary, community-rated supplement to Part A and B benefits for traditional Medicare beneficiaries. This program will cover deductibles, copayments, and other cost-sharing amounts, including balance billing, with a $100 annual deductible and no pre-existing condition limitations. The legislation also repeals certain health provisions from a prior reconciliation act and authorizes the inclusion of Medicare buy-in enrollees in health demonstrations conducted by the Center for Medicare and Medicaid Innovation.