Improving Medicare Coverage Act

To amend titles II and XVIII of the Social Security Act to lower the Medicare eligibility age to 60, and for other purposes. 1. Short title This Act may be cited as the Improving Medicare Coverage Act 2. Medicare Eligibility Expansion (a) In general Section 226 of the Social Security Act ( 42 U.S.C. 426 (1) by striking 65 60 (2) in subsection (a)— (A) in paragraph (2)(A)— (i) by inserting would be entitled to those benefits but for age, section 202, (ii) by inserting (not including age) meets all the criteria (B) in the matter at the end— (i) by inserting , in the case of an individual who has attained age 65 before the date that is 6 months after the date of the enactment of the Improving Medicare Coverage Act beginning with (ii) by inserting and, in the case of an individual who has not attained age 65 before the date that is 6 months after the date of the enactment of the Improving Medicare Coverage Act and (2) (b) Enrollment periods for part B benefits Section 1837(d) of the Social Security Act ( 42 U.S.C. 1395p(d) (1) by striking (d) In the case of (d)(1) Subject to paragraph (2), in the case of (2) by adding at the end the following new paragraph: (2) In the case of an individual described in paragraph (1) who has attained the age of 60 but not attained the age of 65 before the date that is 6 months after the date of the enactment of the Improving Medicare Coverage Act . (c) Conforming amendments (1) Hospital insurance benefits for the aged Section 1811 of the Social Security Act ( 42 U.S.C. 1395c (A) by striking 65 60 (B) by striking (or would be eligible for such benefits if certain government employment were covered employment under such title) (or would be eligible for such benefits if certain government employment were covered employment under such title, or would be eligible for such benefits but for age) (2) Hospital insurance benefits for uninsured elderly individuals not otherwise eligible Section 1818 of such Act ( 42 U.S.C. 1395i–2 (A) in subsection (a)(1), by striking 65 60 (B) in subsection (d)— (i) in paragraph (1), by striking 65 60 (ii) in paragraph (3), by striking 65 60 (3) Hospital insurance benefits for disabled individuals who have exhausted other entitlement Section 1818A(a)(1) of such Act (42 U.S.C. 1395i–2a(a)(1)) is amended by striking 65 60 (4) Eligible individuals Section 1836(2) of such Act ( 42 U.S.C. 1395o(2) 65 60 (5) Enrollment periods Section 1837 of such Act ( 42 U.S.C. 1395p 65 60 (6) Coverage period Section 1838 of the such Act ( 42 U.S.C. 1395q (A) by striking 65 60 (B) in subsection (a)(2)— (i) by striking subsection (d) subsection (d)(1) (ii) in subparagraph (D), by striking ; or , or (iii) by adding at the end the following new subparagraph: (E) in the case of an individual who enrolls pursuant to subsection (d)(2) of section 1837, on the date that is 6 months after the date of the enactment of the Improving Medicare Coverage Act . (7) Amounts of premiums Section 1839 of such Act ( 42 U.S.C. 1395r (A) in subsection (a)(1)— (i) by striking the first sentence and inserting The Secretary shall, during September of 1983 through September of 2021, determine the monthly actuarial rate for enrollees age 65 and over which shall be applicable for the succeeding calendar year (including, for 2022, with respect to individuals who enroll pursuant to subsection (d)(2) of section 1837) and, during September of 2022 and of each year thereafter, determine the monthly actuarial value for enrollees age 60 and over which shall be applicable for the succeeding calendar year. (ii) by inserting (for years before 2023 and with respect to those enrollees age 50 or older (for 2023 and subsequent years) age 60 and older (B) in subsection (a)(3)— (i) by striking for enrollees age 65 and over, determined according to paragraph (1), determined according to paragraph (1) (ii) by striking age 65 and older (C) in subsection (a)(4)— (i) by striking the first sentence and inserting The Secretary shall, during September of 1983 through September of 2021, determine the monthly actuarial rate for disabled enrollees under age 65 which shall be applicable for the succeeding calendar year and, during September of 2022 and of each year thereafter, determine the monthly actuarial value for disabled enrollees under age 60 which shall be applicable for the succeeding calendar year. (ii) by inserting (for years before 2023) and with respect to those disabled enrollees under age 60 (for 2023 and subsequent years) to disabled enrollees under age 65 (D) in subsection (b), by inserting (in the case of an individual who attained the age of 65 before the date that is 6 months after the date of the enactment of the Improving Medicare Coverage Act the age of 65 (E) in subsection (d), by inserting (in the case of an individual who attained the age of 65 before the date that is 6 months after the date of the enactment of the Improving Medicare Coverage Act age 65 (F) in subsection (i)(3)(A), by inserting (for years before 2023) or for enrollees age 60 and older (for 2023 and subsequent years) age 65 and older (G) in subsection (j), by inserting (for years before 2023) or for enrollees age 60 and older (for 2023 and subsequent years) age 65 and older (8) Appropriations to cover government contributions and contingency reserve Section 1844(a) of such Act ( 42 U.S.C. 1395w(a) 65 60 (9) Eligibility, election, and enrollment Section 1851(e)(4) of such Act ( 42 U.S.C. 1395w–21(e)(4) 65 60 (10) Premiums; late enrollment penalty Section 1860D–13(b)(7)(B)(i) of such Act ( 42 U.S.C. 1395w–113(b)(7)(B)(i) (in the case of an individual who attained the age of 65 before the date that is 6 months after the date of the enactment of the Improving Medicare Coverage Act 65 (11) Individuals at risk for diabetes Section 1861(yy)(2)(F)(iv) of such Act ( 42 U.S.C. 1395x(yy)(2)(F)(iv) 65 60 (12) Exclusions from coverage and Medicare as a secondary payer Section 1862(b)(1)(A)(i)(II) of such Act ( 42 U.S.C. 1395y(b)(1)(A)(i)(II) 65 60 (13) Certification of Medicare supplemental health insurance policies Section 1882(s) of such Act ( 42 U.S.C. 1395ss(s) (A) in paragraph (2)— (i) in subparagraph (A), by striking 65 years of age or older entitled to benefits under part A under subsection (a) of section 226, or would be entitled to benefits under such subsection but for paragraph (2) of such subsection, (ii) in subparagraph (D), by inserting (in the case of an individual who attained the age of 65 before the date that is 6 months after the date of the enactment of the Improving Medicare Coverage Act older (B) in paragraph (3)(B)— (i) in clause (ii), by inserting (in the case of an individual who attained the age of 65 before the date that is 6 months after the date of the enactment of the Improving Medicare Coverage Act older (ii) in clause (vi), by striking eligible for benefits under part A at age 65 entitled to part A benefits under section 226(a) (14) Hospital providers of extended care services Section 1883(z)(2)(A) of such Act ( 42 U.S.C. 1395tt(z)(2)(A) (in the case of an individual who attained the age of 65 before the date that is 6 months after the date of the enactment of the Improving Medicare Coverage Act 65 (15) Medicare subvention demonstration project for military retirees Section 1896(a)(4) of such Act ( 42 U.S.C. 1395ggg(a)(4) (A) in subparagraph (B)— (i) in clause (i), by striking benefits under part A of this title part A benefits under section 226(a) (ii) in clause (ii), by striking the semicolon at the end and inserting ; and (B) in subparagraph (C), by striking ; and (C) by striking subparagraph (D). (d) Eligibility for premium assistance Coverage provided under the Medicare program under title XVIII of the Social Security Act pursuant to this section (relating to coverage of individuals who have attained the age of 60 but have not attained the age of 65) shall be treated as coverage under a qualified health plan in the individual market enrolled in through an Exchange where the individual resides for purposes of section 36B (e) Automatic enrollment of individuals entitled to part A The Secretary of Health and Human Services shall establish procedures to provide for the automatic enrollment of individuals who become entitled to benefits under part A of title XVIII of the Social Security Act as of the date that is 6 months after the date of the enactment of this Act pursuant to this section in descending order of age with enrollment of such individuals beginning not later than 3 months after such date of enactment and completed not later than 11 months after such date of enactment. (f) Clarification regarding coverage of dependents Nothing in this section shall be construed to— (1) provide coverage under the Medicare program of a dependent who is not otherwise eligible for such coverage as an individual; or (2) affect a dependent’s eligibility under a group health plan, qualified health plan offered on an Exchange, or any other health plan for which the dependent is otherwise eligible. (g) Clarification of Medicare as secondary payer Nothing in this section shall affect the requirements under section 1862(b) of the Social Security Act ( 42 U.S.C. 1395y(b) (h) Effective date (1) In general Subject to paragraph (2), the amendments made by this section shall take effect on the date that is 6 months after the date of the enactment of this Act. (2) Exceptions The amendments made by subsection (b) and subsection (c)(1)(G) shall take effect on the date of enactment of this Act. 3. Medicare Cost Assistance Program (a) In general Title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq. 1899B. Medicare Cost Assistance Program (a) In general Effective beginning on the date that is 6 months after the date of the enactment of the Improving Medicare Coverage Act (1) (A) premiums under section 1818; and (B) premiums under section 1839. (2) Coinsurance under this title (including coinsurance described in section 1813). (3) Deductibles established under this title (including those described in section 1813 and section 1833(b)). (4) The difference between the amount that is paid under section 1833(a) and the amount that would be paid under such section if any reference to a percent less than 100 percent therein were deemed a reference to 100 percent (b) Determination of eligibility (1) Medicare Cost Assistance Program eligible individual defined The term Medicare Cost Assistance Program eligible individual (A) is eligible for and is receiving medical assistance for the payment of medicare cost-sharing under a State Medicaid program pursuant to clause (i), (iii), or (iv) of section 1902(a)(10)(E) as of the day prior to the date that is 6 months after the date of the enactment of the Improving Medicare Coverage Act (B) (i) is entitled to hospital insurance benefits under part A (including an individual entitled to such benefits pursuant to an enrollment under section 1818); and (ii) has income at or below 200 percent of the poverty line applicable to a family of the size involved. (2) Joint determination by Commissioner of Social Security for LIS and Medicare cost assistance (A) In general The determination of whether an individual is a Medicare Cost Assistance Program eligible individual described in paragraph (1) shall be determined by the Commissioner of Social Security jointly with the determination of whether an individual is a subsidy eligible individual described in section 1860D–14(a)(3). Such determination shall be made with respect to eligibility for Medicare cost assistance under this section and premium and cost-sharing subsidies under section 1860D–14 upon application of an individual for a determination with respect to eligibility for either such assistance or such subsidies. There are authorized to be appropriated to the Social Security Administration such sums as may be necessary for the determination of eligibility under this paragraph. (B) Effective period Determinations under this paragraph with respect to eligibility for each of such assistance or such subsidies shall be effective beginning with the month in which the individual applies for a determination described in subparagraph (A) and shall remain in effect until such time as the Secretary determines the individual is no longer eligible as determined under subparagraph (C)(ii). (C) Redeterminations With respect to eligibility determinations under this paragraph— (i) redeterminations shall be made at the same time with respect to eligibility for Medicare cost assistance under this section and cost-sharing subsidies under section 1860D–14, but not more frequently than once every 12 months; (ii) a redetermination shall automatically determine that an individual remains eligible for such assistance or subsidies unless— (I) the Commissioner has information indicating that the individual's circumstances have changed such that the individual is no longer eligible for such assistance or subsidies; (II) the Commissioner sends notice to the individual regarding such information that requests a response either confirming or correcting such information; and (III) the individual either confirms such information or fails to provide documentation indicating that such circumstances have not changed within 60 days of receiving the notice described in subclause (II); (iii) the Commissioner shall establish procedures for appeals of such determinations that are similar to the procedures described in the third sentence of section 1631(c)(1)(A); and (iv) judicial review of the final decision of the Commissioner made after a hearing shall be available to the same extent, and with the same limitations, as provided in subsections (g) and (h) of section 205. (D) Treatment of medicaid beneficiaries The Secretary shall provide that individuals who are full-benefit dual eligible individuals (as defined in section 1935(c)(6)) or who are recipients of supplemental security income benefits under title XVI shall be treated as a Medicare Cost Assistance Program eligible individual described in paragraph (1) and, in the case of such individual who is a part D eligible individual, a subsidy eligible individual described in section 1860D–14(a)(3). (E) Simplified application form (i) In general The Secretary shall develop and distribute a simplified application form for use by individuals in applying for Medicare cost assistance under this section and premium and cost-sharing subsidies under section 1860D–14. Such form shall be easily readable by applicants and uniform nationally. The Secretary shall provide for the translation of such application form into at least the 10 languages (other than English) that are most often used by individuals applying for hospital insurance benefits under section 226 or 226A and shall make the translated forms available to the Commissioner of Social Security. (ii) Consultation In developing such form, the Secretary shall consult with beneficiary groups. (3) Income determinations For purposes of applying this section— (A) in the case of an individual who is not treated as a Medicare Cost Assistance Program eligible individual or a subsidy eligible individual under paragraph (2)(D), income shall be determined in the manner described under section 1612 for purposes of the supplemental security income program, except that support and maintenance furnished in kind shall not be counted as income; and (B) the term poverty line 42 U.S.C. 9902(2) (c) Beneficiary protections (1) In general In the case in which the payment for Medicare cost assistance for a Medicare Cost Assistance Program eligible individual with respect to an item or service is reduced or eliminated the individual shall not have any legal liability to make payment to a provider of services or supplier or to an organization described in section 1903(m)(1)(A) for the service, and any lawful sanction that may be imposed upon a provider of services or supplier or such an organization for excess charges under this title or title XIX shall apply to the imposition of any charge imposed upon the individual in such case. (2) Clarification This paragraph shall not be construed as preventing payment of any medicare cost assistance by a medicare supplemental policy or an employer retiree health plan on behalf of an individual. (d) Administration (1) In general The Secretary shall establish procedures for the administration of the program under this section. (2) Funding For purposes of carrying out this section, the Secretary shall make payments from the Federal Hospital Insurance Trust Fund under section 1817 and the Federal Supplementary Medical Insurance Trust Fund under section 1841, in such proportion as the Secretary determines appropriate, of such amounts as the Secretary determines necessary to provide Medicare cost assistance under this section. (e) References to medicare cost-Sharing Effective beginning on the date that is 6 months after the date of the enactment of the Improving Medicare Coverage Act (f) Outreach efforts For provisions relating to outreach efforts to increase awareness of the availability of Medicare cost assistance, see section 1144. . (b) Special enrollment period (1) No premium penalty Section 1839(b) of the Social Security Act ( 42 U.S.C. 1395r(b) or, effective beginning on the date that is 6 months after the date of the enactment of the Improving Medicare Coverage Act (2) Special enrollment period Section 1837 of the Social Security Act ( 42 U.S.C. 1395p (o) Special enrollment period for Medicare Cost Assistance Program eligible individual (1) In general Effective beginning on the date that is 6 months after the date of the enactment of the Improving Medicare Coverage Act (2) Coverage period In the case of an individual who enrolls during the special enrollment period provided under paragraph (1), the coverage period under this part shall— (A) begin on the first day of the first month in which the individual applies for a determination under section 1899B(b)(2)(A); and (B) remain in effect until such time as the Secretary determines the individual no longer eligible as determined under section 1899B(b)(2)(C)(ii). . (3) Conforming sunset of State agreements relating to enrollment of qualified medicare beneficiaries (A) Part A Section 1818(g) of the Social Security Act ( 42 U.S.C. 1395i–2(g) (3) Sunset This subsection shall not apply on or after the date that is 6 months after the date of the enactment of the Improving Medicare Coverage Act . (B) Part B Section 1843(h) of the Social Security Act ( 42 U.S.C. 1395v(h) (3) Sunset with respect to qualified medicare beneficiaries This subsection shall not apply with respect to qualified medicare beneficiaries on or after the date that is 6 months after the date of the enactment of the Improving Medicare Coverage Act . (c) Public awareness campaign Section 1144 of the Social Security Act ( 42 U.S.C. 1320b–14 (d) Public awareness campaign (1) In general The Commissioner shall conduct a public awareness campaign to educate Medicare beneficiaries on the availability of Medicare cost assistance for low-income individuals under section 1899B. (2) Coordination In carrying out such public awareness campaign, the Commissioner shall coordinate with State health insurance assistance programs described in subsection (a)(1)(A) of section 119 of the Medicare Improvements for Patients and Providers Act of 2008 ( 42 U.S.C. 1395b–3 (3) Funding There are hereby appropriated to the Commissioner, out of any funds in the Treasury not otherwise appropriated, $10,000,000 for each of fiscal years 2022 through 2024, to provide grants to State health insurance assistance programs to carry out outreach and education activities under the public awareness campaign pursuant to this subsection. . 4. Moving Medicare cost-sharing benefits from Medicaid to Medicare (a) Ending most Medicare cost-Sharing benefits under Medicaid Section 1902(a)(10) of the Social Security Act ( 42 U.S.C. 1396a(a)(10) (1) by inserting for calendar quarters beginning before the date that is 6 months after the date of the enactment of the Improving Medicare Coverage Act for making (2) in the matter following subparagraph (G)— (A) by inserting furnished during calendar quarters beginning before the date that is 6 months after the date of the enactment of the Improving Medicare Coverage Act (described in section 1905(p)(3)) (B) by striking (XV) , (XV) (C) by striking and (XVIII) , (XVIII) (D) by inserting , and (XIX) no medical assistance for medicare cost-sharing, other than medical assistance for medicare cost-sharing for qualified disabled and working individuals described in section 1905(s), shall be made available after the date that is 6 months after the date of the enactment of the Improving Medicare Coverage Act (b) Conforming amendments (1) Title XIX (A) Section 1903(i) of such Act ( 42 U.S.C. 1396b(i) (i) in paragraph (26), by striking ; and (ii) in paragraph (27), by striking the period at the end and inserting ; and (iii) by inserting after paragraph (27) the following new paragraph: (28) with respect to any amount expended for medical assistance for medicare cost-sharing (other than medical assistance for medicare cost-sharing for qualified disabled and working individuals described in section 1905(s)) furnished during calendar quarters beginning on or after the date that is 6 months after the date of the enactment of the Improving Medicare Coverage Act . (B) Section 1905(a) of such Act ( 42 U.S.C. 1396d(a) furnished during calendar quarters beginning before the date that is 6 months after the date of the enactment of the Improving Medicare Coverage Act medicare cost-sharing (C) Section 1933(g) of such Act ( 42 U.S.C. 1396u–3(g) (i) in paragraph (2)(Q), by striking paragraph (4), for each subsequent year paragraphs (4) and (5), for each subsequent year (prior to the date that is 6 months after the date of the enactment of the Improving Medicare Coverage Act (ii) by adding at the end the following: (5) Sunset No individual shall be selected to be a qualifying individual for any calendar year or period under this section beginning on or after the date that is 6 months after the date of the enactment of the Improving Medicare Coverage Act . (D) Section 1935(a) of such Act ( 42 U.S.C. 1396u–5(a) (i) in paragraph (2), by striking make determinations prior to the date that is 6 months after the date of the enactment of the Improving Medicare Coverage Act (ii) in paragraph (3), by inserting prior to the date that is 6 months after the date of the enactment of the Improving Medicare Coverage Act the State shall (2) Title XI Section 1144 of the Social Security Act ( 42 U.S.C. 1320b–14 (A) in subsection (a)— (i) in paragraph (1)(A)— (I) by striking sections 1902(a)(10)(E) and 1933 section 1902(a)(10)(E) and (prior to the date that is 6 months after the date of the enactment of the Improving Medicare Coverage Act (II) by striking for the transitional assistance under section 1860D–31(f), or (III) by inserting , or for Medicare premium and cost-sharing assistance under section 1899B (in the case of months beginning on or after the date that is 6 months after the date of the enactment of the Improving Medicare Coverage Act (ii) by striking paragraph (2) and inserting the following: (2) Content of notice Any notice furnished under paragraph (1) shall state that eligibility for such medical assistance, subsidies, or program is conditioned upon meeting the applicable eligibility criteria. ; (B) in subsection (b)(1)(A)— (i) by striking sections 1902(a)(10)(E) and 1933 section 1902(a)(10)(E) and (prior to the date that is 6 months after the date of the enactment of the Improving Medicare Coverage Act (ii) by striking for transitional assistance under section 1860D–31(f), or (iii) by inserting , or for Medicare premium and cost-sharing assistance under section 1899B (C) in subsection (c)— (i) in paragraph (1)(B), by inserting , and (beginning on the date that is 6 months after the date of the enactment of the Improving Medicare Coverage Act (ii) in paragraph (2), in the paragraph header, by inserting medicare savings program application and lis application (iii) in paragraph (7), by striking means the program of medical assistance (A) prior to the date that is 6 months after the date of the enactment of the Improving Medicare Coverage Act (B) beginning on the date that is 6 months after the date of the enactment of the Improving Medicare Coverage Act . (c) Ensuring that Medicare cost-Sharing beneficiaries under Medicaid receive Medicare cost assistance Not later than 3 months after the date of the enactment of this Act, the Secretary of Health and Human Services and the Commissioner of Social Security shall jointly develop and implement a transition plan to ensure that all individuals who are eligible for and are receiving medical assistance for the payment of medicare cost-sharing under a State Medicaid program pursuant to clauses (i), (iii), and (iv) of section 1902(a)(10)(E) of the Social Security Act ( 42 U.S.C. 1396a(a)(10)(E) 5. Enhancing prescription drug affordability by expanding access to assistance with out-of-pocket costs under Medicare part D for low-income seniors and individuals with disabilities (a) Expanding access Section 1860D–14 of the Social Security Act ( 42 U.S.C. 1395w–114 (1) in subsection (a)— (A) in the heading, by striking 150 percent 200 percent (B) in paragraph (1)— (i) in the heading, by striking 135 percent 200 percent (ii) in the matter preceding subparagraph (A)— (I) by striking 135 percent 200 percent (II) by striking and who meets the resources requirement described in paragraph (3)(D) or who is covered under this paragraph under paragraph (3)(B)(i) or who is covered under this paragraph under paragraph (3)(B)(v) (C) by striking paragraph (2); (D) in paragraph (3)— (i) in subparagraph (A)— (I) in clause (i), by adding and (II) in clause (ii)— (aa) by striking 150 percent 200 percent (bb) by striking ; and (III) by striking clause (iii); (ii) by striking subparagraphs (B) and (C) and inserting the following: (B) Determinations For provisions relating to joint determinations with respect to eligibility for Medicare cost assistance under section 1899B and premium and cost-sharing subsidies under this section, see section 1899B(b)(2). (C) Income determinations For purposes of applying this section— (i) in the case of an individual who is not treated as a Medicare cost-sharing assistance eligible individual and a subsidy eligible individual under section 1899B(b)(2)(D), income shall be determined in the manner described under section 1612 for purposes of the supplemental security income program, except that support and maintenance furnished in kind shall not be counted as income; and (ii) the term poverty line 42 U.S.C. 9902(2) ; and (iii) by striking subparagraphs (D), (E), and (G); and (E) in paragraph (4), by striking subparagraph (B); and (2) in subsection (c)(1), in the second sentence, by striking subsections (a)(1)(D) and (a)(2)(E) subsection (a)(1)(D) (b) Treatment of reduction of cost-Sharing for individuals receiving home and community based services Section 1860D–14(a)(1)(D) of the Social Security Act ( 42 U.S.C. 1395w–114(a)(1)(D) (1) by striking who would be such an institutionalized individual or couple, if the full-benefit dual eligible individual were not (2) by striking or subsection (c) or (d) of section 1915 or under a State plan amendment under subsection (i) of such section , section 1115A, section 1915, or under a State plan amendment (c) Effective date The amendments made by this section shall apply to plan years beginning on or after the date that is 6 months after the date of the enactment of this Act, and apply on or after such date. 6. Sunset Effective on the date that is 5 years after the date that is 6 months after the date of the enactment of the Improving Medicare Coverage Act

Summary: Improving Medicare Coverage Act This bill temporarily expands eligibility for Medicare. It also temporarily establishes a premium and cost-sharing assistance program for low-income beneficiaries. Specifically, the bill lowers the age of eligibility for Medicare from 65 to 60. The Centers for Medicare &amp; Medicaid Services must establish procedures to provide for automatic enrollment of qualifying individuals. Enrollment must be completed within 11 months of the bill's enactment. The bill also establishes a program under Medicare to assist low-income Medicare beneficiaries with premiums, coinsurance, deductibles, and other costs. Currently, such assistance is provided through Medicare Savings Programs, which are administered by state Medicaid programs. The bill also establishes a related special enrollment period under Medicare, expands eligibility for assistance to beneficiaries with income up to 200% of the federal poverty line, and provides for joint eligibility determinations with respect to the bill's program and the low-income subsidy program under the Medicare prescription drug benefit. The bill's provisions generally take effect six months after the bill's enactment and terminate five years later.