The IAFF supports the Expanding Health Care Options for Early Retirees Act to allow retired public safety officers, including fire fighters and EMS personnel, to buy into Medicare at age 50 and encourages members of Congress to cosponsor the bill.

Current Legislation

HR 4148: Introduced by Representative Tom Malinowski (D-NJ)
S 2236: Introduced by Senator Sherrod Brown (D-OH)

Summary: The Expanding Health Care Options for Early Retirees Act would allow retired fire fighters, EMTs and police officers who do not have access to any state, local or federal health plans or affordable employer-sponsored health care to buy into Medicare at age 50.


Fire fighters and emergency medical services (EMS) personnel work in dangerous and demanding conditions day in and day out, taking a serious toll on their physical and mental health. Due to the unique aspects of the profession, public safety officers often retire well before the age of 60. As a result, such workers must obtain affordable and comprehensive health coverage until they become eligible for Medicare at age 65.

As costs steadily increase, the search for comprehensive coverage is quickly becoming a real challenge. When a fire fighter retires early in the United States, they are given essentially three options for post-retirement healthcare. The first, and least realistic option, is for a fire fighter to have their insurance plan paid in full by their former employer until age 65.As health costs continue to rise, we will likely see this already rare benefit disappear. Once this happens, workers will be left with their remaining two options. One of those options allows workers to buy back into their old health plan at a substantially higher rate, which may or may not include a small stipend to help supplement the increased cost. The third option, which is quickly becoming the norm, is purchasing healthcare on a state or federal exchange or out on the open market at a much higher rate and without any subsidy assistance from the employer.

A worker’s healthcare challenges can be made worse by their limited retirement earnings. Roughly 75 percent of fire fighters around the country will not receive Social Security, and depending on a fire fighter’s work history, his or her pension benefit can be as low as $30,000 per year. When a fire fighter’s employer decides to forego a post-retirement health benefit, the cost of a quality healthcare plan skyrockets and the value of his or her retirement plan craters.

Medicare buy-in at 50 could help ease the transition from work to retirement for public safety workers. Early Medicare buy-in would provide an additional option for accessing health insurance at an affordable rate. These savings produce an added benefit whereby a public safety worker gets to keep more of their hard-earned savings to use for other essential needs after they leave work.

Key Points

Fire fighters generally retire earlier than other workers, leaving many with gaps in access to quality health insurance

  • The fire service requires a high level of physical exertion and takes a serious toll on a worker’s physical abilities. As a result, many employers require fire fighters to retire as early as age 50, leaving workers burdened with securing expensive health insurance. Many fire fighters find themselves in this limbo for over a decade until they reach the age of Medicare eligibility.
  • Early retirement is usually linked to the physically demanding aspects of the profession. When compared to fellow fire fighters, studies find that general markers for fitness decline as a fire fighter ages, including overall physical fitness, body weight, blood pressure, aerobic capacity and likelihood of musculoskeletal injuries. When compared to private sector workers, fire fighters are more likely to suffer a workplace injury as well as take longer to return from said injury.
  • In addition to the physical demands of the occupation, studies show that fire fighters are significantly more at risk for contracting various types of cancers. Fire fighters respond to and work in extremely dangerous environments, exposing them to toxins, chemicals and carcinogens. If a retired fire fighter should get sick because of service to their community, he or she should not have to worry about finding quality healthcare. Medicare at age 50 would provide an additional option to a retiree to ensure the best possible care.

Finding quality health insurance on the open market can be difficult and expensive

  • Fire fighters have few options to gain access to quality health insurance once they retire. Costs associated with state and ACA exchanges are unpredictable year to year and vary depending on where one lives. Painful uncertainty can result when state exchanges see premium costs fluctuate wildly and insurance providers move in and out of communities on a year-to-year basis.Early Medicare buy-in could provide more certainty for a high-need group like public safety workers.
  • Buying insurance on the open market as an alternative comes with its own set of obstacles for entry. Without an employer plan and larger participant pool, rejection for coverage can occur. Studies show that individuals ages 50 to 64 represent the group most frequently rejected from buying coverage on the open market. Early Medicare buy-in would provide the necessary certainty and peace of mind for getting coverage after retirement.

Allowing public safety workers the option to buy into Medicare will not increase costs

  • This legislation specifically states that if enacted, it will have no negative impact on the Medicare Trust Fund. In fact, costs overall may decrease due to the addition of younger participants into the Medicare pool.
  • An estimated 7,000 fire fighters retire each year, including those under the age of 50 who will receive continued health insurance through their employer. Nearly 2 million individuals are added to the Medicare rolls each year. Adding eligible police retirees and fire fighters to this figure will have a negligible impact on the system and its 44 million members.

Printable PDFs:

Fact Sheet

Key Points