II 

114TH CONGRESS 

2D SESSION S. 3371 

To amend titles II, XVIII, and XIX of the Social Security Act to improve 

the affordability and enrollment procedures of the Medicare program, 

and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

SEPTEMBER 21, 2016 

Mr. WYDEN (for himself, Ms. STABENOW, Mr. BENNET, Mr. NELSON, and 

Mr. BROWN) introduced the following bill; which was read twice and referred to the Committee on Finance 

A BILL 

To amend titles II, XVIII, and XIX of the Social Security 

Act to improve the affordability and enrollment procedures of the Medicare program, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Medicare Affordability and Enrollment Act of 2016’’. 

6 (b) TABLE OF CONTENTS.—The table of contents of 

7 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Protecting against high out-of-pocket expenditures for Medicare fee-forservice benefits. 


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Sec. 3. Reducing cost-sharing, aligning income and resource eligibility tests, 

and simplifying enrollment for low-income beneficiaries. 

Sec. 4. Reducing Medicare cost-sharing for low-income beneficiaries. 

Sec. 5. Eliminating the 24-month waiting period for Medicare coverage for individuals with disabilities. 

Sec. 6. Improving Medicare beneficiary enrollment procedures and effective 

dates of coverage. 

Sec. 7. Eliminating exclusion of part D eligible individuals residing in territories from eligibility for premium and cost-sharing subsidies. 

Sec. 8. Extending funding for low-income Medicare beneficiary outreach and assistance education activities. 

1 SEC. 2. PROTECTING AGAINST HIGH OUT-OF-POCKET EX2 PENDITURES FOR MEDICARE FEE-FOR-SERV3 ICE BENEFITS. 

4 Title XVIII of the Social Security Act (42 U.S.C. 

5 1395 et seq.) is amended by adding at the end the fol6 lowing new section: 

7 ‘‘PROTECTION AGAINST HIGH OUT-OF-POCKET

8 EXPENDITURES

9 ‘‘SEC. 1899C. (a) IN GENERAL.—Notwithstanding 

10 any other provision of this title, in the case of an indi11 vidual entitled to, or enrolled for, benefits under part A 

12 or enrolled in part B, if the amount of the out-of-pocket 

13 cost-sharing of such individual for a year (beginning with 

14 2018) equals or exceeds the annual out-of-pocket limit 

15 under subsection (b) for that year— 

16 ‘‘(1) the amount otherwise payable under part 

17 A and the total amount of expenses incurred by the 

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1 able under part B, shall be 100 percent of such 

2 amount for the remainder of that year; and 

3 ‘‘(2) the individual shall not be responsible for 

4 out-of-pocket cost-sharing incurred during the re5 mainder of that year. 

6 ‘‘(b) ANNUAL OUT-OF-POCKET LIMIT.— 

7 ‘‘(1) IN GENERAL.—The amount of the annual 

8 out-of-pocket limit under this subsection shall be— 

9 ‘‘(A) for 2018, $5,500; or 

10 ‘‘(B) for a subsequent year, the amount 

11 specified in this subsection for the preceding 

12 year increased or decreased by the percentage 

13 change in the Consumer Price Index for All 

14 Urban Consumers for the 12-month period end15 ing with June of such preceding year. 

16 ‘‘(2) ROUNDING.—If any amount determined 

17 under paragraph (1)(B) is not a multiple of $5, such 

18 amount shall be rounded to the nearest multiple of 

19 $5. 

20 ‘‘(c) OUT-OF-POCKET COST-SHARING DEFINED.— 

21 ‘‘(1) IN GENERAL.—Subject to paragraphs (2) 

22 and (3), in this section, the term ‘out-of-pocket cost23 sharing’ means, with respect to an individual, the 

24 amount of the expenses incurred by the individual 

25 that are attributable to— 


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1 ‘‘(A) deductibles, coinsurance and copay2 ments applicable under part A or B; or 

3 ‘‘(B) for items and services that would 

4 have otherwise been covered under part A or B 

5 but for the exhaustion of those benefits. 

6 ‘‘(2) CERTAIN COSTS NOT INCLUDED.— 

7 ‘‘(A) NON-COVERED ITEMS AND SERV8 ICES.—Expenses incurred for items and serv9 ices which are not covered under part A or B 

10 shall not be considered incurred expenses for 

11 purposes of determining out-of-pocket cost12 sharing under paragraph (1). 

13 ‘‘(B) ITEMS AND SERVICES NOT FUR14 NISHED ON AN ASSIGNMENT-RELATED BASIS.— 

15 If an item or service is furnished to an indi16 vidual under this title and is not furnished on 

17 an assignment-related basis, any additional ex18 penses the individual incurs above the amount 

19 the individual would have incurred if the item 

20 or service was furnished on an assignment-re21 lated basis shall not be considered incurred ex22 penses for purposes of determining out-of-pock23 et cost-sharing under paragraph (1). 

24 ‘‘(3) SOURCE OF PAYMENT.—For purposes of 

25 paragraph (1), the Secretary shall consider expenses 


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1 to be incurred by the individual without regard to 

2 whether the individual or another person, including 

3 a State program, an employer, a medicare supple4 mental policy, or other third-party coverage, has 

5 paid for such expenses. 

6 ‘‘(d) ANNOUNCEMENT OF THE ANNUAL OUT-OF7 POCKET LIMIT.—The Secretary shall (beginning in 2017) 

8 announce (in a manner intended to provide notice to all 

9 interested parties) the annual out-of-pocket limit under 

10 this section that will be applicable for the succeeding 

11 year.’’. 

12 SEC. 3. REDUCING COST-SHARING, ALIGNING INCOME AND 

13 RESOURCE ELIGIBILITY TESTS, AND SIMPLI14 FYING ENROLLMENT FOR LOW-INCOME 

15 BENEFICIARIES. 

16 (a) INCREASE IN INCOME ELIGIBILITY TO 135 PER17 CENT OF FPL FOR QUALIFIED MEDICARE BENE18 FICIARIES.—Section 1905(p)(2) of the Social Security Act 

19 (42 U.S.C. 1396d(p)(2)) is amended— 

20 (1) in subparagraph (A), by striking ‘‘100 per21 cent’’ and inserting ‘‘135 percent’’; 

22 (2) in subparagraph (B)— 

23 (A) by striking ‘‘and’’ at the end of clause 

24 (ii); 


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1 (B) by striking the period at the end of 

2 clause (iii) and inserting ‘‘, and’’; and 

3 (C) by adding at the end the following: 

4 ‘‘(iv) January 1, 2018, is 135 percent.’’; and 

5 (3) in subparagraph (C)— 

6 (A) by striking ‘‘and’’ at the end of clause 

7 (iii); 

8 (B) by striking the period at the end of 

9 clause (iv) and inserting ‘‘, and’’; and 

10 (C) by adding at the end the following: 

11 ‘‘(v) January 1, 2018, is 135 percent.’’. 

12 (b) INCREASE IN INCOME ELIGIBILITY TO 150 PER13 CENT OF FPL FOR SPECIFIED LOW-INCOME MEDICARE

14 BENEFICIARIES.— 

15 (1) ELIGIBILITY OF INDIVIDUALS WITH IN16 COMES BELOW 150 PERCENT OF FPL.—Section 

17 1902(a)(10)(E) of the Social Security Act (42 

18 U.S.C. 1396b(a)(10)(E)) is amended— 

19 (A) by adding ‘‘and’’ at the end of clause 

20 (ii); 

21 (B) in clause (iii)— 

22 (i) by striking ‘‘and 120 percent in 

23 1995 and years thereafter’’ and inserting 

24 ‘‘120 percent in 1995 and years thereafter 


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1 before 2018, and 150 percent in 2018 and 

2 years thereafter’’; and 

3 (ii) by striking ‘‘and’’ at the end; and 

4 (C) by striking clause (iv). 

5 (2) REFERENCES.—Section 1905(p)(1) of such 

6 Act (42 U.S.C. 1396d(p)(1)) is amended by adding 

7 at and below subparagraph (C) the following flush 

8 sentence: 

9 ‘‘The term ‘specified low-income medicare beneficiary’ 

10 means an individual described in section 

11 1902(a)(10)(E)(iii).’’. 

12 (3) CONFORMING AMENDMENTS.— 

13 (A) The first sentence of section 1905(b) 

14 of such Act (42 U.S.C. 1396d(b)) is amended 

15 by striking ‘‘and section 1933(d)’’. 

16 (B) Section 1933 of such Act (42 U.S.C. 

17 1396u–3) is repealed. 

18 (c) 100 PERCENT FMAP.—Section 1905 of the So19 cial Security Act (42 U.S.C. 1396d) is amended by adding 

20 at the end the following new subsection: 

21 ‘‘(ee) INCREASED FMAP FOR EXPANDED MEDICARE

22 COST-SHARING POPULATIONS.— 

23 ‘‘(1) IN GENERAL.—Notwithstanding subsection 

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1 graph (2) the Federal medical assistance percentage 

2 shall be equal to 100 percent. 

3 ‘‘(2) EXPENDITURES DESCRIBED.—The expend4 itures described in this paragraph are expenditures 

5 made on or after January 1, 2018, for medical as6 sistance for medicare cost-sharing provided to any 

7 individual under clause (i), (ii), or (iii) of section 

8 1902(a)(10)(E) who would not have been eligible for 

9 medicare cost-sharing under any such clause under 

10 the income or resource eligibility standards in effect 

11 on October 1, 2016.’’. 

12 (d) CONSOLIDATION OF LOW-INCOME SUBSIDY RE13 SOURCE ELIGIBILITY TESTS.— 

14 (1) IN GENERAL.—Section 1860D–14(a)(3) of 

15 the Social Security Act (42 U.S.C. 1395w– 

16 114(a)(3)) is amended— 

17 (A) by striking subparagraph (D); 

18 (B) by redesignating subparagraphs (E) 

19 through (G) as subparagraphs (D) through (F), 

20 respectively; and 

21 (C) in the heading of subparagraph (D), as 

22 so redesignated, by striking ‘‘ALTERNATIVE’’. 

23 (2) CLARIFICATION OF CERTAIN RULES RELAT24 ING TO INCOME AND RESOURCE DETERMINA25 TIONS.—Section 1860D–14(a)(3) of the Social SecuVerDate Sep 11 2014 03:58 Sep 23, 2016 Jkt 059200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S3371.IS S3371

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1 rity Act (42 U.S.C. 1395w–114(a)(3)), as amended 

2 by paragraph (1), is amended by striking subpara3 graph (F) and inserting the new following new sub4 paragraphs: 

5 ‘‘(F) RESOURCE EXCLUSIONS.—In deter6 mining the resources of an individual (and the 

7 eligible spouse of the individual, if any) under 

8 section 1613 for purposes of subparagraph 

9 (D)— 

10 ‘‘(i) no part of the value of any life in11 surance policy shall be taken into account; 

12 ‘‘(ii) no part of the value of any vehi13 cle shall be taken into account; and 

14 ‘‘(iii) there shall be excluded an 

15 amount equal to $1,500 each with respect 

16 to any individual or eligible spouse of an 

17 individual who attests that some of the re18 sources of such individual or spouse will be 

19 used to meet the burial and related ex20 penses of such individual or spouse. 

21 ‘‘(G) FAMILY SIZE.—In determining the 

22 size of the family of an individual for purposes 

23 of determining the income eligibility of such in24 dividual under this section, an individual’s fam25 ily shall consist of— 


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1 ‘‘(i) the individual; 

2 ‘‘(ii) the individual’s spouse who lives 

3 in the same household as the individual (if 

4 any); and 

5 ‘‘(iii) any other individuals who— 

6 ‘‘(I) are related to the individual 

7 whose income eligibility is in question 

8 or such individual’s spouse who lives 

9 in the same household; 

10 ‘‘(II) are living in the same 

11 household as such individual; and 

12 ‘‘(III) are dependent on such in13 dividual or such individual’s spouse 

14 who is living in the same household 

15 for at least one-half of their financial 

16 support.’’. 

17 (3) CONFORMING AMENDMENTS.—Section 

18 1860D–14(a) of the Social Security Act (42 U.S.C. 

19 1395w–114(a)) is amended— 

20 (A) in paragraph (1), in the matter pre21 ceding subparagraph (A), by inserting ‘‘(as de22 termined under paragraph (3)(G))’’ after ‘‘fam23 ily of the size involved’’; and 

24 (B) in paragraph (3), as amended by para25 graphs (1) and (2)— 


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1 (i) in subparagraph (A), in the matter 

2 preceding clause (i), by striking ‘‘subpara3 graph (F)’’ and inserting ‘‘subparagraph 

4 (E)’’; 

5 (ii) in subparagraph (A)(ii), by insert6 ing ‘‘(as determined under subparagraph 

7 (G))’’ after ‘‘family of the size involved’’; 

8 (iii) in subparagraph (A)(iii), by strik9 ing ‘‘or (E)’’; 

10 (iv) in subparagraph (B)(v), in the 

11 matter preceding subclause (I), by striking 

12 ‘‘subparagraph (F)’’ and inserting ‘‘sub13 paragraph (E)’’; and 

14 (v) in subparagraph (D)(i), in the 

15 matter preceding subclause (I), by striking 

16 ‘‘subject to the life insurance policy exclu17 sion provided under subparagraph (G)’’ 

18 and inserting ‘‘subject to the resource ex19 clusions provided under subparagraph 

20 (F)’’. 

21 (e) ALIGNMENT OF LOW-INCOME SUBSIDY AND

22 MEDICARE SAVINGS PROGRAM INCOME AND RESOURCE

23 ELIGIBILITY TESTS.— 


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1 (1) APPLICATION OF MEDICAID SPOUSAL IM2 POVERISHMENT RESOURCE ALLOWANCE TO MSP AND

3 LIS RESOURCE ELIGIBILITY.— 

4 (A) IN GENERAL.—Section 1905(p)(1)(C) 

5 of the Social Security Act (42 U.S.C. 

6 1396d(p)(1)(C)) is amended to read as follows: 

7 ‘‘(C) whose resources (as determined under sec8 tion 1613 for purposes of the supplemental security 

9 income program subject to the resource exclusions 

10 under subparagraph (F) of section 1860D–14(a)(3)) 

11 do not exceed— 

12 ‘‘(i) in the case of an individual with a 

13 spouse, an amount equal to the sum of the first 

14 amount specified in subsection (f)(2)(A)(i) of 

15 section 1924 (as adjusted under subsection (g) 

16 of such section) and the amount specified in 

17 subsection (f)(2)(A)(ii)(II) of such section (as 

18 so adjusted); or 

19 ‘‘(ii) in the case of an individual who does 

not have a spouse, an amount equal to 1 20 ⁄2 of 

21 the amount described in clause (i).’’. 

22 (B) APPLICATION TO QDWIS.—Section 

23 1905(s)(3) of the Social Security Act (42 

24 U.S.C. 1396d(s)(3)) is amended to read as fol25 lows: 


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1 ‘‘(3) whose resources (as determined under sec2 tion 1613 for purposes of the supplemental security 

3 income program subject to the resource exclusions 

4 under subparagraph (F) of section 1860D–14(a)(3)) 

5 do not exceed— 

6 ‘‘(A) in the case of an individual with a 

7 spouse, the amount in effect for the year under 

8 clause (i) of subsection (p)(1)(C); and 

9 ‘‘(B) in the case of an individual who does 

10 not have a spouse, the amount in effect for the 

11 year under clause (ii) of subsection (p)(1)(C); 

12 and’’. 

13 (C) APPLICATION TO LIS.—Clause (i) of 

14 section 1860D–14(a)(3)(D), as redesignated 

15 and amended by subsection (d)(1), is amended 

16 to read as follows: 

17 ‘‘(i) IN GENERAL.—The resources re18 quirement of this subparagraph is that an 

19 individual’s resources (as determined under 

20 section 1613 for purposes of the supple21 mental security income program subject to 

22 the resource exclusions provided under 

23 subparagraph (F)) do not exceed the 

24 amount in effect for the year under section 

25 1905(p)(1)(C)(ii).’’. 


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1 (f) ENROLLMENT SIMPLIFICATIONS.— 

2 (1) APPLICATION OF 3-MONTH RETROACTIVE

3 ELIGIBILITY TO QMBS.— 

4 (A) IN GENERAL.—Section 1902(e)(8) of 

5 the Social Security Act (42 U.S.C. 1396a(e)(8)) 

6 is amended by striking ‘‘after the end of the 

7 month in which the determination first occurs’’ 

8 and inserting ‘‘in or after the third month be9 fore the month in which the individual makes 

10 application for assistance’’. 

11 (B) CONFORMING AMENDMENT.—Section 

12 1905(a) of the Social Security Act (42 U.S.C. 

13 1396d(a)) is amended, in the matter preceding 

14 paragraph (1), by striking ‘‘or, in the case of 

15 medicare cost-sharing with respect to a quali16 fied medicare beneficiary described in sub17 section (p)(1), if provided after the month in 

18 which the individual becomes such a bene19 ficiary’’. 

20 (2) STATE OPTION FOR 12-MONTH CONTINUOUS

21 ELIGIBILITY FOR SLMBS AND QWDIS.—Section 

22 1902(e)(12) of the Social Security Act (42 U.S.C. 

23 1396a(e)(12)) is amended— 

24 (A) by redesignating subparagraphs (A) 

25 and (B) as clauses (i) and (ii), respectively; 


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1 (B) by inserting ‘‘(A)’’ after ‘‘(12)’’; and 

2 (C) by adding at the end the following: 

3 ‘‘(B) At the option of the State, the plan may provide 

4 that an individual who is determined to be eligible for ben5 efits under a State plan approved under this title under 

6 any of the following eligibility categories, or who is rede7 termined to be eligible for such benefits under any of such 

8 categories, shall be considered to meet the eligibility re9 quirements met on the date of application and shall re10 main eligible for those benefits until the end of the 12- 

11 month period following the date of the determination or 

12 redetermination of eligibility, except that a State may pro13 vide for such determinations more frequently, but not 

14 more frequently than once every 6 months for an indi15 vidual: 

16 ‘‘(i) A specified low-income medicare beneficiary 

17 described in subsection (a)(10)(E)(iii) of this section 

18 who is determined eligible for medicare cost sharing 

19 described in section 1905(p)(3)(A)(ii). 

20 ‘‘(ii) A qualified disabled and working indi21 vidual described in section 1905(s) who is deter22 mined eligible for medicare cost-sharing described in 

23 section 1905(p)(3)(A)(i).’’. 

24 (3) STATE OPTION TO USE EXPRESS LANE ELI25 GIBILITY FOR THE MEDICARE SAVINGS PROGRAM.— 


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1 Section 1902(e)(13)(A) of the Social Security Act 

2 (42 U.S.C. 1396a(e)(13)(A)) is amended by adding 

3 at the end the following new clause: 

4 ‘‘(iii) STATE OPTION TO EXTEND EX5 PRESS LANE ELIGIBILITY TO OTHER POPU6 LATIONS.— 

7 ‘‘(I) IN GENERAL.—At the option 

8 of the State, the State may apply the 

9 provisions of this paragraph with re10 spect to determining eligibility under 

11 this title for an eligible individual (as 

12 defined in subclause (II)). In applying 

13 this paragraph in the case of a State 

14 making such an option, any reference 

15 in this paragraph to a child with re16 spect to this title (other than a ref17 erence to child health assistance) shall 

18 be deemed to be a reference to an eli19 gible individual. 

20 ‘‘(II) ELIGIBLE INDIVIDUAL DE21 FINED.—In this clause, the term ‘eli22 gible individual’ means any of the fol23 lowing: 

24 ‘‘(aa) A qualified medicare 

25 beneficiary described in section 


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1 1905(p)(1) for purposes of deter2 mining eligibility for medicare 

3 cost-sharing (as defined in sec4 tion 1905(p)(3)). 

5 ‘‘(bb) A specified low-income 

6 medicare beneficiary described in 

7 subsection (a)(10)(E)(iii) of this 

8 section for purposes of deter9 mining eligibility for medicare 

10 cost-sharing described in section 

11 1905(p)(3)(A)(ii). 

12 ‘‘(cc) A qualified disabled 

13 and working individual described 

14 in section 1905(s) for purposes of 

15 determining eligibility for medi16 care cost-sharing described in 

17 section 1905(p)(3)(A)(i). 

18 ‘‘(dd) During the period 

19 that begins on the date of enact20 ment of this clause and ends on 

21 December 31, 2017, a qualifying 

22 individual described in subsection 

23 (a)(10)(E)(iv) for purposes of de24 termining eligibility for medicare 


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1 cost-sharing described in section 

2 1905(p)(3)(A)(ii).’’. 

3 (g) EFFECTIVE DATE.— 

4 (1) IN GENERAL.—Except as provided in para5 graphs (2) and (3), the amendments and repeal 

6 made by this section take effect on January 1, 2018, 

7 and, with respect to title XIX of the Social Security 

8 Act, apply to calendar quarters beginning on or after 

9 January 1, 2018. 

10 (2) EXPRESS LANE ELIGIBILITY FOR MSP.— 

11 The amendments made by subsection (f)(3) take ef12 fect on the date of enactment of this Act. 

13 (3) EXCEPTION FOR STATE LEGISLATION.—In 

14 the case of a State plan for medical assistance under 

15 title XIX of the Social Security Act which the Sec16 retary of Health and Human Services determines re17 quires State legislation (other than legislation appro18 priating funds) in order for the plan to meet the ad19 ditional requirements imposed by the amendments 

20 and repeal made by this section (other than the 

21 amendments made by subsection (f)(3)), the State 

22 plan shall not be regarded as failing to comply with 

23 the requirements of such title solely on the basis of 

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1 ning after the close of the first regular session of the 

2 State legislature that begins after the date of the en3 actment of this Act. For purposes of the previous 

4 sentence, in the case of a State that has a 2-year 

5 legislative session, each year of such session shall be 

6 deemed to be a separate regular session of the State 

7 legislature. 

8 SEC. 4. REDUCING MEDICARE COST-SHARING FOR LOW-IN9 COME BENEFICIARIES. 

10 (a) IN GENERAL.—Title XVIII of the Social Security 

11 Act (42 U.S.C. 1395 et seq.), as amended by section 2, 

12 is amended by adding at the end the following new section: 

13 ‘‘REDUCTION IN MEDICARE COST-SHARING FOR LOW14 INCOME BENEFICIARIES

15 ‘‘SEC. 1899D. (a) IN GENERAL.—Notwithstanding 

16 any other provision of this title, in the case of items and 

17 services furnished on or after January 1, 2018, to an ap18 plicable low-income individual, the amount of any coinsur19 ance or copayment otherwise applicable to the item or 

20 service under part A or B shall be reduced by 50 percent. 

21 ‘‘(b) APPLICABLE LOW-INCOME INDIVIDUAL DE22 FINED.— 

23 ‘‘(1) IN GENERAL.—In this section, the term 

24 ‘applicable low-income individual’ means an indi25 vidual— 


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1 ‘‘(A) entitled to, or enrolled for, benefits 

2 under part A or enrolled in part B; 

3 ‘‘(B) who is determined to have income 

4 that is greater than 135 percent and less than 

5 or equal to 200 percent of the poverty line ap6 plicable to a family of the size involved; and 

7 ‘‘(C) whose resources (as determined under 

8 section 1613 for purposes of the supplemental 

9 security income program subject to the resource 

10 exclusions provided under section 1860D– 

11 14(a)(3)(F)) do not exceed the amount in effect 

12 for the year under section 1905(p)(1)(C)(ii). 

13 ‘‘(2) INCOME DETERMINATIONS.—For purposes 

14 of applying this section— 

15 ‘‘(A) income shall be determined in the 

16 manner described in section 1905(p)(1)(B), 

17 without regard to the application of section 

18 1902(r)(2); and 

19 ‘‘(B) ‘poverty line’ has the meaning given 

20 such term in section 673(2) of the Community 

21 Services Block Grant Act (42 U.S.C. 9902(2)), 

22 including any revision required by such section. 

23 Nothing in subparagraph (A) shall be construed to 

24 affect the application of section 1902(r)(2) for the 


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1 determination of eligibility for medical assistance 

2 under title XIX. 

3 ‘‘(c) ESTABLISHMENT OF PROCEDURES FOR IDENTI4 FICATION OF APPLICABLE LOW-INCOME INDIVIDUALS

5 AND NOTIFICATION OF PROVIDERS OF SERVICES AND

6 SUPPLIERS.— 

7 ‘‘(1) IN GENERAL.—The Secretary, in consulta8 tion with the Commissioner of Social Security and 

9 the Secretary of the Treasury, shall establish proce10 dures for— 

11 ‘‘(A) the determination of whether an indi12 vidual is an applicable low-income individual; 

13 and 

14 ‘‘(B) the notification of providers of serv15 ices and suppliers in the case where an indi16 vidual is an applicable low-income individual so 

17 that the reduction in any coinsurance or copay18 ment under subsection (a) is applied at the time 

19 the item or service is provided to the applicable 

20 low-income individual. 

21 ‘‘(2) DETERMINATIONS.— 

22 ‘‘(A) IN GENERAL.—The provisions of sec23 tion 1860D–14(a)(3)(B)(i) shall apply to the 

24 determination of whether an individual is an 

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1 tion in the same manner as such provisions 

2 apply to the determination of whether a part D 

3 eligible is a subsidy eligible individual under 

4 section 1860D–14(a)(3)(B)(i). 

5 ‘‘(B) EFFECTIVE PERIOD.—Determina6 tions under this subsection shall be effective for 

7 a period determined appropriate by the Sec8 retary. 

9 ‘‘(d) NO EFFECT ON PAYMENT TO PROVIDERS OF

10 SERVICES OR SUPPLIERS.—Notwithstanding any other 

11 provision of this title, in the case of an item or service 

12 for which the reduction in coinsurance or copayment under 

13 subsection (a) applies, the amount of payment otherwise 

14 applicable for the item or service under part A or B shall 

15 be increased by the amount of the reduction in coinsur16 ance or copayment under such subsection.’’. 

17 (b) DISCLOSURE.—Section 6103(l)(7)(D)(ii) of the 

18 Internal Revenue Code of 1986 is amended— 

19 (1) by striking ‘‘or subsidies’’ and inserting ‘‘, 

20 subsidies’’; and 

21 (2) by inserting ‘‘, or reduced cost-sharing pro22 vided under section 1899D’’ before the period at the 

23 end. 


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1 SEC. 5. ELIMINATING THE 24-MONTH WAITING PERIOD FOR 

2 MEDICARE COVERAGE FOR INDIVIDUALS 

3 WITH DISABILITIES. 

4 (a) IN GENERAL.—Section 226(b) of the Social Secu5 rity Act (42 U.S.C. 426(b)) is amended— 

6 (1) in paragraph (2)(A), by striking ‘‘, and has 

7 for 24 calendar months been entitled to,’’; 

8 (2) in paragraph (2)(B), by striking ‘‘, and has 

9 been for not less than 24 months,’’; 

10 (3) in paragraph (2)(C)(ii), by striking ‘‘, in11 cluding the requirement that he has been entitled to 

12 the specified benefits for 24 months,’’; 

13 (4) in the first sentence, by striking ‘‘for each 

14 month beginning with the later of (I) July 1973 or 

15 (II) the twenty-fifth month of his entitlement or sta16 tus as a qualified railroad retirement beneficiary de17 scribed in paragraph (2), and’’ and inserting ‘‘for 

18 each month for which the individual meets the re19 quirements of paragraph (2), beginning with the 

20 month following the month in which the individual 

21 meets the requirements of such paragraph, and’’; 

22 and 

23 (5) in the second sentence, by striking ‘‘the 

24 ‘twenty-fifth month of his entitlement’ ’’ and all that 

25 follows through ‘‘paragraph (2)(C) and’’. 

26 (b) CONFORMING AMENDMENTS.— 


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1 (1) SECTION 226.—Section 226 of the Social 

2 Security Act (42 U.S.C. 426) is amended by— 

3 (A) striking subsections (e)(1)(B), (f), and 

4 (h); and 

5 (B) redesignating subsections (g) and (i) 

6 as subsections (f) and (g), respectively. 

7 (2) MEDICARE DESCRIPTION.—Section 1811(2) 

8 of the Social Security Act (42 U.S.C. 1395c(2)) is 

9 amended by striking ‘‘have been entitled for not less 

10 than 24 months’’ and inserting ‘‘are entitled’’. 

11 (3) MEDICARE COVERAGE.—Section 1837(g)(1) 

12 of the Social Security Act (42 U.S.C. 1395p(g)(1)) 

13 is amended by striking ‘‘25th month of’’ and insert14 ing ‘‘month following the first month of’’. 

15 (4) RAILROAD RETIREMENT SYSTEM.—Section 

16 7(d)(2)(ii) of the Railroad Retirement Act of 1974 

17 (45 U.S.C. 231f(d)(2)(ii)) is amended— 

18 (A) by striking ‘‘has been entitled to an 

19 annuity’’ and inserting ‘‘is entitled to an annu20 ity’’; 

21 (B) by striking ‘‘, for not less than 24 

22 months’’; and 

23 (C) by striking ‘‘could have been entitled 

24 for 24 calendar months, and’’. 


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1 (c) EFFECTIVE DATE.—The amendments made by 

2 this section shall apply to insurance benefits under title 

3 XVIII of the Social Security Act with respect to items and 

4 services furnished in months beginning after December 

5 2017. 

6 SEC. 6. IMPROVING MEDICARE BENEFICIARY ENROLL7 MENT PROCEDURES AND EFFECTIVE DATES 

8 OF COVERAGE. 

9 (a) GENERAL ENROLLMENT PERIOD.—Section 

10 1837(e) of the Social Security Act (42 U.S.C. 1395p(e)) 

11 is amended to read as follows: 

12 ‘‘(e) GENERAL AND SPECIAL ENROLLMENT PERI13 ODS.— 

14 ‘‘(1) GENERAL ENROLLMENT.— 

15 ‘‘(A) FOR COVERAGE DURING YEARS BE16 FORE 2018.—There shall be a general enroll17 ment period during the period beginning on 

18 January 1 and ending on March 31 of each 

19 year before 2018. 

20 ‘‘(B) FOR COVERAGE DURING YEARS BE21 GINNING WITH 2018.—Subject to subparagraph 

22 (B), there shall be a general enrollment period 

23 beginning on October 15 and ending on Decem24 ber 31 of 2017 and each subsequent year. 


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1 ‘‘(2) SPECIAL ENROLLMENT.—Beginning Janu2 ary 1, 2018, the Secretary shall establish special en3 rollment periods in the case of an individual who 

4 meets such exceptional conditions as the Secretary 

5 may provide.’’. 

6 (b) EFFECTIVE DATES OF COVERAGE.— 

7 (1) IN GENERAL.—Section 1838(a) of the So8 cial Security Act (42 U.S.C. 1395q(a)) is amend9 ed— 

10 (A) by amending paragraph (2) to read as 

11 follows: 

12 ‘‘(2)(A) in the case of an individual who enrolls 

13 pursuant to subsection (d) of section 1837 before 

14 the month in which he first satisfies paragraph (1) 

15 or (2) of section 1836, the first day of such month, 

16 or 

17 ‘‘(B) in the case of an individual not described 

18 in subparagraph (A) who first satisfies such para19 graph in a month beginning before January 1, 2018, 

20 and who enrolls— 

21 ‘‘(i) pursuant to such subsection (d) in 

22 such month in which he first satisfies such 

23 paragraph, the first day of the month following 

24 the month in which he so enrolls, or 


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1 ‘‘(ii) pursuant to such subsection (d) in the 

2 month following such month in which he first 

3 satisfies such paragraph, the first day of the 

4 second month following the month in which he 

5 so enrolls, or 

6 ‘‘(iii) pursuant to such subsection (d) more 

7 than one month following such month in which 

8 he satisfies such paragraph, the first day of the 

9 third month following the month in which he so 

10 enrolls, or 

11 ‘‘(C) in the case of an individual not described 

12 in subparagraph (A) who enrolls pursuant to sub13 section (e) of section 1837 in a month beginning— 

14 ‘‘(i) before April 1, 2017, the July 1 fol15 lowing the month in which he so enrolls, or 

16 ‘‘(ii) on or after October 1, 2017, the first 

17 day of the month following the month in which 

18 he so enrolls, or 

19 ‘‘(D) in the case of an individual not described 

20 in subparagraph (A) who first satisfies such para21 graph in a month beginning on or after January 1, 

22 2018, and who enrolls pursuant to such subsection 

23 (d) in such month in which he first satisfies such 

24 paragraph or in any subsequent month in the initial 


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•S 3371 IS

1 enrollment period, the first day of the month fol2 lowing the month in which he so enrolls; or’’; and 

3 (B) in paragraph (3), by striking ‘‘sub4 paragraphs (B), (C), (D), and (E) of paragraph 

5 (2) of this subsection’’ and inserting ‘‘subpara6 graphs (B) and (C) of paragraph (2), as appli7 cable’’. 

8 (2) TECHNICAL CORRECTION.—Section 1839(b) 

9 of the Social Security Act (42 U.S.C. 1395r(b)) is 

10 amended, in the second sentence, by striking ‘‘close 

11 of the enrollment period’’ each place it appears and 

12 inserting ‘‘close of the month’’. 

13 (c) APPLICATION OF THE PART A LATE ENROLL14 MENT PENALTY TIME LIMITATION PROVISION TO THE

15 PART B LATE ENROLLMENT PENALTY.— 

16 (1) IN GENERAL.—Section 1839(b) of the So17 cial Security Act (42 U.S.C. 1395r(b)) is amended 

18 by adding at the end the following new sentence: 

19 ‘‘Any percent increase in an individual’s monthly 

20 premium under the first sentence shall only apply to 

21 premiums paid during a period equal to twice the 

22 number of months in the full 12-month periods de23 scribed in the first sentence.’’. 

24 (2) CONFORMING AMENDMENT TO THE PART A

25 LATE ENROLLMENT PENALTY.—Section 1818(c)(6) 


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1 of the Social Security Act (42 U.S.C. 1395i–2(c)(6)) 

2 is amended by striking ‘‘and shall only apply to pre3 miums paid during a period equal to twice the num4 ber of months in the full 12-month periods described 

5 in that section’’. 

6 (3) EFFECTIVE DATE.— 

7 (A) IN GENERAL.—The amendments made 

8 by this section shall take effect on the date of 

9 the enactment of this Act and shall apply to 

10 premiums for months beginning on or after 

11 January 1, 2018. 

12 (B) COUNTING OF MONTHS.—In applying 

13 the amendment made by paragraph (1), months 

14 (occurring before, during, or after the month 

15 that includes the date of the enactment of this 

16 Act) in which an individual’s monthly premium 

17 is increased under subsection (b) of section 

18 1839 of the Social Security Act (42 U.S.C. 

19 1395r) shall be taken into account in deter20 mining whether the limitation under the last 

21 sentence of such subsection (b), as added by 

22 paragraph (1), is applicable. 

23 (d) APPLICATION OF PART B DEEMED ENROLLMENT

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1 ROLLMENT PERIOD AND LIMIT ON LATE ENROLLMENT

2 PENALTIES.— 

3 (1) APPLICATION OF PART B DEEMED ENROLL4 MENT PROCESS TO RESIDENTS OF PUERTO RICO.— 

5 Section 1837(f)(3) of the Social Security Act (42 

6 U.S.C. 1395p(f)(3)) is amended by striking ‘‘, exclu7 sive of Puerto Rico’’. 

8 (2) EFFECTIVE DATE.—The amendment made 

9 by paragraph (1) shall apply to individuals whose 

10 initial enrollment period under section 1837(d) of 

11 the Social Security Act begins on or after the first 

12 day of the effective month, specified by the Sec13 retary of Health and Human Services under section 

14 1839(j)(1)(C) of such Act, as added by subsection 

15 (c)(2). 

16 (3) TRANSITION PROVIDING SPECIAL ENROLL17 MENT PERIOD AND LIMIT ON LATE ENROLLMENT

18 PENALTIES FOR CERTAIN MEDICARE BENE19 FICIARIES.—Section 1839 of the Social Security Act 

20 (42 U.S.C. 1395r) is amended— 

21 (A) in the first sentence of subsection (b), 

22 by inserting ‘‘subject to section 1839(j)(2),’’ 

23 after ‘‘subsection (i)(4) or (l) of section 1837,’’; 

24 and 


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1 (B) by adding at the end the following new 

2 subsection: 

3 ‘‘(j) SPECIAL RULES FOR CERTAIN RESIDENTS OF

4 PUERTO RICO.— 

5 ‘‘(1) SPECIAL ENROLLMENT PERIOD, COVERAGE

6 PERIOD FOR RESIDENTS WHO ARE ELIGIBLE BUT

7 NOT ENROLLED.— 

8 ‘‘(A) IN GENERAL.—In the case of a tran9 sition individual (as defined in paragraph (3)) 

10 who is not enrolled under this part as of the 

11 day before the first day of the effective month 

12 (as defined in subparagraph (C)), the Secretary 

13 shall provide for a special enrollment period 

14 under section 1837 of 7 months beginning with 

15 such effective month during which the indi16 vidual may be enrolled under this part. 

17 ‘‘(B) COVERAGE PERIOD.—In the case of 

18 such an individual who enrolls during such spe19 cial enrollment period, the coverage period 

20 under section 1838 shall begin on the first day 

21 of the second month after the month in which 

22 the individual enrolls. 

23 ‘‘(C) EFFECTIVE MONTH DEFINED.—In 

24 this section, the term ‘effective month’ means a 

25 month, not earlier than October 2017 and not 


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•S 3371 IS

1 later than January 2018, specified by the Sec2 retary. 

3 ‘‘(2) REDUCTION IN LATE ENROLLMENT PEN4 ALTIES FOR CURRENT ENROLLEES AND INDIVID5 UALS ENROLLING DURING TRANSITION.— 

6 ‘‘(A) IN GENERAL.—In the case of a tran7 sition individual who is enrolled under this part 

8 as of the day before the first day of the effec9 tive month or who enrolls under this part on or 

10 after the date of the enactment of this sub11 section but before the end of the special enroll12 ment period under paragraph (1)(A), the 

13 amount of the late enrollment penalty imposed 

14 under section 1839(b) shall be recalculated by 

15 reducing the penalty to 15 percent of the pen16 alty otherwise established. 

17 ‘‘(B) APPLICATION.—Subparagraph (A) 

18 shall be applied in the case of a transition indi19 vidual who— 

20 ‘‘(i) is enrolled under this part as of 

21 the month before the effective month, for 

22 premiums for months beginning with such 

23 effective month; or 

24 ‘‘(ii) enrolls under this part on or 

25 after the date of the enactment of this Act 


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•S 3371 IS

1 and before the end of the special enroll2 ment period under paragraph (1)(A), for 

3 premiums for months during the coverage 

4 period under this part which occur during 

5 or after the effective month. 

6 ‘‘(C) LOSS OF REDUCTION IF INDIVIDUAL

7 TERMINATES ENROLLMENT.—Subparagraph 

8 (A) shall not apply to a transition individual if 

9 the individual terminates enrollment under this 

10 part after the end of the special enrollment pe11 riod under paragraph (1). 

12 ‘‘(3) TRANSITION INDIVIDUAL DEFINED.—In 

13 this section, the term ‘transition individual’ means 

14 an individual who resides in Puerto Rico and who 

15 would have been deemed enrolled under this part 

16 pursuant to section 1837(f) before the first day of 

17 the effective month but for the fact that the indi18 vidual was a resident of Puerto Rico, regardless of 

19 whether the individual is enrolled under this part as 

20 of such first day.’’. 


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•S 3371 IS

1 SEC. 7. ELIMINATING EXCLUSION OF PART D ELIGIBLE IN2 DIVIDUALS RESIDING IN TERRITORIES FROM 

3 ELIGIBILITY FOR PREMIUM AND COST-SHAR4 ING SUBSIDIES. 

5 (a) IN GENERAL.—Section 1860D–14(a)(3) of the 

6 Social Security Act (42 U.S.C. 1395w–114(a)(3)), as 

7 amended by section 3(d), is amended— 

8 (1) in subparagraph (A), in the matter pre9 ceding clause (i), by striking ‘‘subject to subpara10 graph (E),’’; 

11 (2) in subparagraph (B)(v), in the matter pre12 ceding subclause (I), by striking ‘‘Subject to sub13 paragraph (E), the Secretary’’ and inserting ‘‘The 

14 Secretary’’; 

15 (3) in subparagraph (C), by adding at the end 

16 the following new sentence: ‘‘In the case of an indi17 vidual who is not a resident of the 50 States or the 

18 District of Columbia, the poverty line (as such term 

19 is defined in clause (ii)) that shall apply to such in20 dividual shall be the poverty line for the 48 contig21 uous States and the District of Columbia.’’; 

22 (4) by striking subparagraph (E), as redesig23 nated by section 3(d)(1); and 

24 (5) by redesignating subparagraphs (F) and 

25 (G), as added by section 3(d)(2), as subparagraphs 

26 (E) and (F), respectively. 


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1 (b) APPLICATION OF MEDICAID PROVISIONS.—Sec2 tion 1935 of the Social Security Act (42 U.S.C. 1396u– 

3 5) is amended— 

4 (1) in subsection (a), by striking ‘‘subject to 

5 subsection (e)’’ in the matter preceding paragraph 

6 (1); and 

7 (2) by striking subsection (e). 

8 (c) CONFORMING AMENDMENTS.— 

9 (1) Section 1108(f) of the Social Security Act 

10 (42 U.S.C. 1308(f)) is amended by striking ‘‘and 

11 section 1935(e)(1)(B)’’ in the matter preceding 

12 clause (i). 

13 (2) Section 1860D–14(a) of the Social Security 

14 Act (42 U.S.C. 1395w–114(a)), as amended by sec15 tion 3(d), is amended— 

16 (A) in paragraph (1), in the matter pre17 ceding subparagraph (A), by striking ‘‘subpara18 graph (3)(G)’’ and inserting ‘‘subparagraph 

19 (3)(F)’’; and 

20 (B) in paragraph (3)— 

21 (i) in subparagraph (A)(ii), by strik22 ing ‘‘subparagraph (G)’’ and inserting 

23 ‘‘subparagraph (F)’’; and 


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1 (ii) in subparagraph (D)(i), by strik2 ing ‘‘subparagraph (F)’’ and inserting 

3 ‘‘subparagraph (E)’’. 

4 (3) Section 1905 of the Social Security Act (42 

5 U.S.C. 1396d) is amended— 

6 (A) in subsection (p)— 

7 (i) in paragraph (1)(C), by striking 

8 ‘‘subparagraph (F)’’ and inserting ‘‘sub9 paragraph (E)’’; and 

10 (ii) in clause (iii) of paragraph (2)(D), 

11 as added by section 3(e)(2)(A)(ii), by strik12 ing ‘‘section 1860D–14(a)(3)(G)’’ and in13 serting ‘‘section 1860D–14(a)(3)(F)’’; and 

14 (B) in subsection (s)— 

15 (i) in paragraph (2), by striking ‘‘sec16 tion 1860D–14(a)(3)(G)’’ and inserting 

17 ‘‘section 1860D–14(a)(3)(F)’’; and 

18 (ii) in paragraph (3), by striking 

19 ‘‘subparagraph (F)’’ and inserting ‘‘sub20 paragraph (E)’’. 

21 (d) EFFECTIVE DATE.—The amendments made by 

22 this section shall take effect on January 1, 2017. 


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1 SEC. 8. EXTENDING FUNDING FOR LOW-INCOME MEDICARE 

2 BENEFICIARY OUTREACH AND ASSISTANCE 

3 EDUCATION ACTIVITIES. 

4 (a) ADDITIONAL FUNDING FOR STATE HEALTH IN5 SURANCE PROGRAMS.—Section 119 of the Medicare Im6 provements for Patients and Providers Act of 2008 (42 

7 U.S.C. 1395b–3 note), as amended by section 3306 of the 

8 Patient Protection and Affordable Care Act (Public Law 

9 111–148), section 610 of the American Taxpayer Relief 

10 Act of 2012 (Public Law 112–240), section 1110 of the 

11 Pathway for SGR Reform Act of 2013 (Public Law 113– 

12 67), section 110 of the Protecting Access to Medicare Act 

13 of 2014 (Public Law 113–93), and section 208 of the 

14 Medicare Access and CHIP Reauthorization Act of 2015 

15 (Public Law 114–10) is amended— 

16 (1) in subsection (a)(1)(B)— 

17 (A) in clause (vi), by striking ‘‘and’’ at the 

18 end; 

19 (B) in clause (vii), by striking the period 

20 at the end and inserting ‘‘; and’’; and 

21 (C) by inserting after clause (vii) at the 

22 end the following new clause: 

23 ‘‘(viii) for fiscal year 2018 and each 

24 subsequent year, of the amount transferred 

25 under this subparagraph for the preceding 

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•S 3371 IS

1 crease determined under subsection (h) for 

2 the fiscal year.’’; and 

3 (2) by adding at the end the following new sub4 section: 

5 ‘‘(h) For purposes of subsections (a)(1)(B)(viii), 

6 (b)(1)(B)(viii), (c)(1)(B)(viii), and (d)(2)(viii), the per7 centage increase determined under this subsection for a 

8 fiscal year is equal to the sum of the— 

9 ‘‘(1) the percentage increase in the consumer 

10 price index for all urban consumers (all items; 

11 United States city average) for the 12-month period 

12 ending with July preceding the beginning of the fis13 cal year; and 

14 ‘‘(2) the percentage increase in the average 

15 number of individuals enrolled in part B of title 

16 XVIII of the Social Security Act, from the preceding 

17 fiscal year to such fiscal year, as estimated by the 

18 Chief Actuary of the Centers for Medicare & Med19 icaid Services.’’. 

20 (b) ADDITIONAL FUNDING FOR AREA AGENCIES ON

21 AGING.—Subsection (b)(1)(B) of such section 119, as so 

22 amended, is amended— 

23 (1) in clause (vi), by striking ‘‘and’’ at the end; 

24 (2) in clause (vii), by striking the period at the 

25 end and inserting ‘‘; and’’; and 


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1 (3) by inserting after clause (vii) the following 

2 new clause: 

3 ‘‘(viii) for fiscal year 2018 and each 

4 subsequent year, of the amount transferred 

5 under this subparagraph for the preceding 

6 fiscal year, increased by the percentage in7 crease determined under subsection (h) for 

8 the fiscal year.’’. 

9 (c) ADDITIONAL FUNDING FOR AGING AND DIS10 ABILITY RESOURCE CENTERS.—Subsection (c)(1)(B) of 

11 such section 119, as so amended, is amended— 

12 (1) in clause (vi), by striking ‘‘and’’ at the end; 

13 (2) in clause (vii), by striking the period at the 

14 end and inserting ‘‘; and’’; and 

15 (3) by inserting after clause (vii) the following 

16 new clauses: 

17 ‘‘(viii) for fiscal year 2018 and each 

18 subsequent year, of the amount transferred 

19 under this subparagraph for the preceding 

20 fiscal year, increased by the percentage in21 crease determined under subsection (h) for 

22 the fiscal year.’’. 

23 (d) ADDITIONAL FUNDING FOR CONTRACT WITH

24 THE NATIONAL CENTER FOR BENEFITS AND OUTREACH


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•S 3371 IS

1 ENROLLMENT.—Subsection (d)(2) of such section 119, as 

2 so amended, is amended— 

3 (1) in clause (vi), by striking ‘‘and’’ at the end; 

4 (2) in clause (vii), by striking the period at the 

5 end and inserting ‘‘; and’’; 

6 (3) by inserting after clause (vii) the following 

7 new clause: 

8 ‘‘(viii) for fiscal year 2018 and each 

9 subsequent year, of the amount transferred 

10 under this paragraph for the preceding fis11 cal year, increased by the percentage in12 crease determined under subsection (h) for 

13 the fiscal year.’’; and 

14 (4) in the flush sentence at the end, by striking 

15 ‘‘subparagraph’’ and inserting ‘‘paragraph’’. 

Æ 


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