I 
114TH CONGRESS 
2D SESSION 
H. R. 6109 
To amend titles 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 HOUSE OF REPRESENTATIVES 
SEPTEMBER 21, 2016 
Mr. PALLONE (for himself, Mr. LEVIN, Mr. GENE GREEN of Texas, and Mr. 
MCDERMOTT) introduced the following bill; which was referred to the 
Committee on Ways and Means, and in addition to the Committees on 
Energy and Commerce, and Transportation and Infrastructure, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration of such provisions as fall within the jurisdiction of the com-
mittee concerned 
A BILL 
To amend titles XVIII and XIX of the Social Security Act 
to improve the affordability and enrollment procedures 
of the Medicare program, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Medicare Affordability and Enrollment Act of 2016’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
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Sec. 1. Short title; table of contents. 
Sec. 2. Protecting against high out-of-pocket expenditures for Medicare fee-for- 
service benefits. 
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 dis-
abled individuals. 
Sec. 6. Improving Medicare beneficiary enrollment procedures and effective 
dates of coverage. 
Sec. 7. Eliminating exclusion of part D eligible individuals residing in terri-
tories from eligibility for premium and cost-sharing subsidies. 
Sec. 8. Extending funding for low-income Medicare beneficiary outreach and as-
sistance education activities. 
SEC. 2. PROTECTING AGAINST HIGH OUT-OF-POCKET EX-
PENDITURES FOR MEDICARE FEE-FOR-SERV-
ICE BENEFITS. 
Title XVIII of the Social Security Act (42 U.S.C. 
1395 et seq.) is amended by adding at the end the fol-
lowing new section: 
‘‘PROTECTION AGAINST HIGH OUT-OF-POCKET 
EXPENDITURES 
‘‘SEC. 1899C. (a) IN GENERAL.—Notwithstanding 
any other provision of this title, in the case of an indi-
vidual entitled to, or enrolled for, benefits under part A 
or enrolled in part B, if the amount of the out-of-pocket 
cost-sharing of such individual for a year (beginning with 
2018) equals or exceeds the annual out-of-pocket limit 
under subsection (b) for that year— 
‘‘(1) the amount otherwise payable under part 
A and the total amount of expenses incurred by the 
individual which would (except for this section) con-
stitute incurred expenses for which benefits are pay-
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‘‘(A) deductibles, coinsurance and copay-
ments applicable under part A or B; or 
‘‘(B) for items and services that would 
have otherwise been covered under part A or B 
but for the exhaustion of those benefits. 
‘‘(2) CERTAIN COSTS NOT INCLUDED.— 
‘‘(A) NON-COVERED
ITEMS
AND
SERV-
ICES.—Expenses incurred for items and serv-
ices which are not covered under part A or B 
shall not be considered incurred expenses for 
purposes of determining out-of-pocket cost- 
sharing under paragraph (1). 
‘‘(B) ITEMS
AND
SERVICES
NOT
FUR-
NISHED ON AN ASSIGNMENT-RELATED BASIS.— 
If an item or service is furnished to an indi-
vidual under this title and is not furnished on 
an assignment-related basis, any additional ex-
penses the individual incurs above the amount 
the individual would have incurred if the item 
or service was furnished on an assignment-re-
lated basis shall not be considered incurred ex-
penses for purposes of determining out-of-pock-
et cost-sharing under paragraph (1). 
‘‘(3) SOURCE OF PAYMENT.—For purposes of 
paragraph (1), the Secretary shall consider expenses 
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to be incurred by the individual without regard to 
whether the individual or another person, including 
a State program, an employer, a medicare supple-
mental policy, or other third-party coverage, has 
paid for such expenses. 
‘‘(d) ANNOUNCEMENT
OF
THE ANNUAL OUT-OF- 
POCKET LIMIT.—The Secretary shall (beginning in 2017) 
announce (in a manner intended to provide notice to all 
interested parties) the annual out-of-pocket limit under 
this section that will be applicable for the succeeding 
year.’’. 
SEC. 3. REDUCING COST-SHARING, ALIGNING INCOME AND 
RESOURCE ELIGIBILITY TESTS, AND SIMPLI-
FYING 
ENROLLMENT 
FOR 
LOW-INCOME 
BENEFICIARIES. 
(a) INCREASE IN INCOME ELIGIBILITY TO 135 PER-
CENT
OF
FPL FOR
QUALIFIED
MEDICARE
BENE-
FICIARIES.—Section 1905(p)(2) of the Social Security Act 
(42 U.S.C. 1396d(p)(2)) is amended— 
(1) in subparagraph (A), by striking ‘‘100 per-
cent’’ and inserting ‘‘135 percent’’; 
(2) in subparagraph (B)— 
(A) by striking ‘‘and’’ at the end of clause 
(ii); 
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(B) by striking the period at the end of 
clause (iii) and inserting ‘‘, and’’; and 
(C) by adding at the end the following: 
‘‘(iv) January 1, 2018, is 135 percent.’’; and 
(3) in subparagraph (C)— 
(A) by striking ‘‘and’’ at the end of clause 
(iii); 
(B) by striking the period at the end of 
clause (iv) and inserting ‘‘, and’’; and 
(C) by adding at the end the following: 
‘‘(v) January 1, 2018, is 135 percent.’’. 
(b) INCREASE IN INCOME ELIGIBILITY TO 150 PER-
CENT OF FPL FOR SPECIFIED LOW-INCOME MEDICARE 
BENEFICIARIES.— 
(1) ELIGIBILITY
OF
INDIVIDUALS
WITH
IN-
COMES
BELOW
150
PERCENT
OF
FPL.—Section 
1902(a)(10)(E) of the Social Security Act (42 
U.S.C. 1396b(a)(10)(E)) is amended— 
(A) by adding ‘‘and’’ at the end of clause 
(ii); 
(B) in clause (iii)— 
(i) by striking ‘‘and 120 percent in 
1995 and years thereafter’’ and inserting 
‘‘120 percent in 1995 and years thereafter 
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before 2018, and 150 percent in 2018 and 
years thereafter’’; and 
(ii) by striking ‘‘and’’ at the end; and 
(C) by striking clause (iv). 
(2) REFERENCES.—Section 1905(p)(1) of such 
Act (42 U.S.C. 1396d(p)(1)) is amended by adding 
at and below subparagraph (C) the following flush 
sentence: 
‘‘The term ‘specified low-income medicare beneficiary’ 
means 
an 
individual 
described 
in 
section 
1902(a)(10)(E)(iii).’’. 
(3) CONFORMING AMENDMENTS.— 
(A) The first sentence of section 1905(b) 
of such Act (42 U.S.C. 1396d(b)) is amended 
by striking ‘‘and section 1933(d)’’. 
(B) Section 1933 of such Act (42 U.S.C. 
1396u–3) is repealed. 
(c) 100 PERCENT FMAP.—Section 1905 of the So-
cial Security Act (42 U.S.C. 1396d) is amended by adding 
at the end the following new subsection: 
‘‘(ee) INCREASED FMAP FOR EXPANDED MEDICARE 
COST-SHARING POPULATIONS.— 
‘‘(1) IN GENERAL.—Notwithstanding subsection 
(b), with respect to expenditures described in para-
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graph (2) the Federal medical assistance percentage 
shall be equal to 100 percent. 
‘‘(2) EXPENDITURES DESCRIBED.—The expend-
itures described in this paragraph are expenditures 
made on or after January 1, 2018, for medical as-
sistance for medicare cost-sharing provided to any 
individual under clause (i), (ii), or (iii) of section 
1902(a)(10)(E) who would not have been eligible for 
medicare cost-sharing under any such clause under 
the income or resource eligibility standards in effect 
on October 1, 2016.’’. 
(d) CONSOLIDATION OF LOW-INCOME SUBSIDY RE-
SOURCE ELIGIBILITY TESTS.— 
(1) IN GENERAL.—Section 1860D–14(a)(3) of 
the Social Security Act (42 U.S.C. 1395w– 
114(a)(3)) is amended— 
(A) by striking subparagraph (D); 
(B) by redesignating subparagraphs (E) 
through (G) as subparagraphs (D) through (F), 
respectively; and 
(C) in the heading of subparagraph (D), as 
so redesignated, by striking ‘‘ALTERNATIVE’’. 
(2) CLARIFICATION OF CERTAIN RULES RELAT-
ING
TO
INCOME
AND
RESOURCE
DETERMINA-
TIONS.—Section 1860D–14(a)(3) of the Social Secu-
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rity Act (42 U.S.C. 1395w–114(a)(3)), as amended 
by paragraph (1), is amended by striking subpara-
graph (F) and inserting the new following new sub-
paragraphs: 
‘‘(F) RESOURCE
EXCLUSIONS.—In deter-
mining the resources of an individual (and the 
eligible spouse of the individual, if any) under 
section 1613 for purposes of subparagraph 
(D)— 
‘‘(i) no part of the value of any life in-
surance policy shall be taken into account; 
‘‘(ii) no part of the value of any vehi-
cle shall be taken into account; and 
‘‘(iii) there shall be excluded an 
amount equal to $1,500 each with respect 
to any individual or eligible spouse of an 
individual who attests that some of the re-
sources of such individual or spouse will be 
used to meet the burial and related ex-
penses of such individual or spouse. 
‘‘(G) FAMILY
SIZE.—In determining the 
size of the family of an individual for purposes 
of determining the income eligibility of such in-
dividual under this section, an individual’s fam-
ily shall consist of— 
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‘‘(i) the individual; 
‘‘(ii) the individual’s spouse who lives 
in the same household as the individual (if 
any); and 
‘‘(iii) any other individuals who— 
‘‘(I) are related to the individual 
whose income eligibility is in question 
or such individual’s spouse who lives 
in the same household; 
‘‘(II) are living in the same 
household as such individual; and 
‘‘(III) are dependent on such in-
dividual or such individual’s spouse 
who is living in the same household 
for at least one-half of their financial 
support.’’. 
(3) 
CONFORMING
AMENDMENTS.—Section 
1860D–14(a) of the Social Security Act (42 U.S.C. 
1395w–114(a)) is amended— 
(A) in paragraph (1), in the matter pre-
ceding subparagraph (A), by inserting ‘‘(as de-
termined under paragraph (3)(G))’’ after ‘‘fam-
ily of the size involved’’; and 
(B) in paragraph (3), as amended by para-
graphs (1) and (2)— 
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(1) APPLICATION
OF
MEDICAID
SPOUSAL
IM-
POVERISHMENT RESOURCE ALLOWANCE TO MSP AND 
LIS RESOURCE ELIGIBILITY.— 
(A) IN GENERAL.—Section 1905(p)(1)(C) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1396d(p)(1)(C)) is amended to read as follows: 
‘‘(C) whose resources (as determined under sec-
tion 1613 for purposes of the supplemental security 
income program subject to the resource exclusions 
under subparagraph (F) of section 1860D–14(a)(3)) 
do not exceed— 
‘‘(i) in the case of an individual with a 
spouse, an amount equal to the sum of the first 
amount specified in subsection (f)(2)(A)(i) of 
section 1924 (as adjusted under subsection (g) 
of such section) and the amount specified in 
subsection (f)(2)(A)(ii)(II) of such section (as 
so adjusted); or 
‘‘(ii) in the case of an individual who does 
not have a spouse, an amount equal to 1⁄2 of 
the amount described in clause (i).’’. 
(B) APPLICATION
TO
QDWIS.—Section 
1905(s)(3) of the Social Security Act (42 
U.S.C. 1396d(s)(3)) is amended to read as fol-
lows: 
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‘‘(3) whose resources (as determined under sec-
tion 1613 for purposes of the supplemental security 
income program subject to the resource exclusions 
under subparagraph (F) of section 1860D–14(a)(3)) 
do not exceed— 
‘‘(A) in the case of an individual with a 
spouse, the amount in effect for the year under 
clause (i) of subsection (p)(1)(C); and 
‘‘(B) in the case of an individual who does 
not have a spouse, the amount in effect for the 
year under clause (ii) of subsection (p)(1)(C); 
and’’. 
(C) APPLICATION TO LIS.—Clause (i) of 
section 1860D–14(a)(3)(D), as redesignated 
and amended by subsection (d)(1), is amended 
to read as follows: 
‘‘(i) IN GENERAL.—The resources re-
quirement of this subparagraph is that an 
individual’s resources (as determined under 
section 1613 for purposes of the supple-
mental security income program subject to 
the resource exclusions provided under 
subparagraph (F)) do not exceed the 
amount in effect for the year under section 
1905(p)(1)(C)(ii).’’. 
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(f) ENROLLMENT SIMPLIFICATIONS.— 
(1) APPLICATION
OF
3-MONTH
RETROACTIVE 
ELIGIBILITY TO QMBS.— 
(A) IN GENERAL.—Section 1902(e)(8) of 
the Social Security Act (42 U.S.C. 1396a(e)(8)) 
is amended by striking ‘‘after the end of the 
month in which the determination first occurs’’ 
and inserting ‘‘in or after the third month be-
fore the month in which the individual makes 
application for assistance’’. 
(B) CONFORMING
AMENDMENT.—Section 
1905(a) of the Social Security Act (42 U.S.C. 
1396d(a)) is amended, in the matter preceding 
paragraph (1), by striking ‘‘or, in the case of 
medicare cost-sharing with respect to a quali-
fied medicare beneficiary described in sub-
section (p)(1), if provided after the month in 
which the individual becomes such a bene-
ficiary’’. 
(2) STATE OPTION FOR 12-MONTH CONTINUOUS 
ELIGIBILITY
FOR
SLMBS
AND
QWDIS.—Section 
1902(e)(12) of the Social Security Act (42 U.S.C. 
1396a(e)(12)) is amended— 
(A) by redesignating subparagraphs (A) 
and (B) as clauses (i) and (ii), respectively; 
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(B) by inserting ‘‘(A)’’ after ‘‘(12)’’; and 
(C) by adding at the end the following: 
‘‘(B) At the option of the State, the plan may provide 
that an individual who is determined to be eligible for ben-
efits under a State plan approved under this title under 
any of the following eligibility categories, or who is rede-
termined to be eligible for such benefits under any of such 
categories, shall be considered to meet the eligibility re-
quirements met on the date of application and shall re-
main eligible for those benefits until the end of the 12- 
month period following the date of the determination or 
redetermination of eligibility, except that a State may pro-
vide for such determinations more frequently, but not 
more frequently than once every 6 months for an indi-
vidual: 
‘‘(i) A specified low-income medicare beneficiary 
described in described in subsection (a)(10)(E)(iii) 
of this section who is determined eligible for medi-
care 
cost 
sharing 
described 
in 
section 
1905(p)(3)(A)(ii). 
‘‘(ii) A qualified disabled and working indi-
vidual described in section 1905(s) who is deter-
mined eligible for medicare cost-sharing described in 
section 1905(p)(3)(A)(i).’’. 
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(3) STATE OPTION TO USE EXPRESS LANE ELI-
GIBILITY FOR THE MEDICARE SAVINGS PROGRAM.— 
Section 1902(e)(13)(A) of the Social Security Act 
(42 U.S.C. 1396a(e)(13)(A)) is amended by adding 
at the end the following new clause: 
‘‘(iii) STATE OPTION TO EXTEND EX-
PRESS LANE ELIGIBILITY TO OTHER POPU-
LATIONS.— 
‘‘(I) IN GENERAL.—At the option 
of the State, the State may apply the 
provisions of this paragraph with re-
spect to determining eligibility under 
this title for an eligible individual (as 
defined in subclause (II)). In applying 
this paragraph in the case of a State 
making such an option, any reference 
in this paragraph to a child with re-
spect to this title (other than a ref-
erence to child health assistance) shall 
be deemed to be a reference to an eli-
gible individual. 
‘‘(II) ELIGIBLE INDIVIDUAL DE-
FINED.—In this clause, the term ‘eli-
gible individual’ means any of the fol-
lowing: 
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‘‘(aa) A qualified medicare 
beneficiary described in section 
1905(p)(1) for purposes of deter-
mining eligibility for medicare 
cost-sharing (as defined in sec-
tion 1905(p)(3)). 
‘‘(bb) A specified low-income 
medicare beneficiary described in 
subsection (a)(10)(E)(iii) of this 
section for purposes of deter-
mining eligibility for medicare 
cost-sharing described in section 
1905(p)(3)(A)(ii). 
‘‘(cc) A qualified disabled 
and working individual described 
in section 1905(s) for purposes of 
determining eligibility for medi-
care cost-sharing described in 
section 1905(p)(3)(A)(i). 
‘‘(dd) During the period 
that begins on the date of enact-
ment of this clause and ends on 
December 31, 2017, a qualifying 
individual described in subsection 
(a)(10)(E)(iv) for purposes of de-
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termining eligibility for medicare 
cost-sharing described in section 
1905(p)(3)(A)(ii).’’. 
(g) EFFECTIVE DATE.— 
(1) IN GENERAL.—Except as provided in para-
graphs (2) and (3), the amendments and repeal 
made by this section take effect on January 1, 2018, 
and, with respect to title XIX of the Social Security 
Act, apply to calendar quarters beginning on or after 
January 1, 2018. 
(2) EXPRESS
LANE
ELIGIBILITY
FOR
MSP.— 
The amendments made by subsection (f)(3) take ef-
fect on the date of enactment of this Act. 
(3) EXCEPTION FOR STATE LEGISLATION.—In 
the case of a State plan for medical assistance under 
title XIX of the Social Security Act which the Sec-
retary of Health and Human Services determines re-
quires State legislation (other than legislation appro-
priating funds) in order for the plan to meet the ad-
ditional requirements imposed by the amendments 
and repeal made by this section (other than the 
amendments made by subsection (f)(3)), the State 
plan shall not be regarded as failing to comply with 
the requirements of such title solely on the basis of 
its failure to meet these additional requirements be-
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fore the first day of the first calendar quarter begin-
ning after the close of the first regular session of the 
State legislature that begins after the date of the en-
actment of this Act. For purposes of the previous 
sentence, in the case of a State that has a 2-year 
legislative session, each year of such session shall be 
deemed to be a separate regular session of the State 
legislature. 
SEC. 4. REDUCING MEDICARE COST-SHARING FOR LOW-IN-
COME BENEFICIARIES. 
(a) IN GENERAL.—Title XVIII of the Social Security 
Act (42 U.S.C. 1395 et seq.), as amended by section 2, 
is amended by adding at the end the following new section: 
‘‘REDUCTION IN MEDICARE COST-SHARING FOR LOW- 
INCOME BENEFICIARIES 
‘‘SEC. 1899D. (a) IN GENERAL.—Notwithstanding 
any other provision of this title, in the case of items and 
services furnished on or after January 1, 2018, to an ap-
plicable low-income individual, the amount of any coinsur-
ance or copayment otherwise applicable to the item or 
service under part A or B shall be reduced by 50 percent. 
‘‘(b) APPLICABLE LOW-INCOME INDIVIDUAL DE-
FINED.— 
‘‘(1) IN GENERAL.—In this section, the term 
‘applicable low-income individual’ means an indi-
vidual— 
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‘‘(A) entitled to, or enrolled for, benefits 
under part A or enrolled in part B; 
‘‘(B) who is determined to have income 
that is greater than 135 percent and less than 
or equal to 200 percent of the poverty line ap-
plicable to a family of the size involved; and 
‘‘(C) whose resources (as determined under 
section 1613 for purposes of the supplemental 
security income program subject to the resource 
exclusions provided under section 1860D– 
14(a)(3)(F)) do not exceed the amount in effect 
for the year under section 1905(p)(1)(C)(ii). 
‘‘(2) INCOME DETERMINATIONS.—For purposes 
of applying this section— 
‘‘(A) income shall be determined in the 
manner described in section 1905(p)(1)(B), 
without regard to the application of section 
1902(r)(2); and 
‘‘(B) ‘poverty line’ has the meaning given 
such term in section 673(2) of the Community 
Services Block Grant Act (42 U.S.C. 9902(2)), 
including any revision required by such section. 
Nothing in subparagraph (A) shall be construed to 
affect the application of section 1902(r)(2) for the 
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determination of eligibility for medical assistance 
under title XIX. 
‘‘(c) ESTABLISHMENT OF PROCEDURES FOR IDENTI-
FICATION
OF APPLICABLE LOW-INCOME INDIVIDUALS 
AND NOTIFICATION OF PROVIDERS OF SERVICES AND 
SUPPLIERS.— 
‘‘(1) IN GENERAL.—The Secretary, in consulta-
tion with the Commissioner of Social Security and 
the Secretary of the Treasury, shall establish proce-
dures for— 
‘‘(A) the determination of whether an indi-
vidual is an applicable low-income individual; 
and 
‘‘(B) the notification of providers of serv-
ices and suppliers in the case where an indi-
vidual is an applicable low-income individual so 
that the reduction in any coinsurance or copay-
ment under subsection (a) is applied at the time 
the item or service is provided to the applicable 
low-income individual. 
‘‘(2) DETERMINATIONS.— 
‘‘(A) IN GENERAL.—The provisions of sec-
tion 1860D–14(a)(3)(B)(i) shall apply to the 
determination of whether an individual is an 
applicable low-income individual under this sec-
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tion in the same manner as such provisions 
apply to the determination of whether a part D 
eligible is a subsidy eligible individual under 
section 1860D–14(a)(3)(B)(i). 
‘‘(B) 
EFFECTIVE
PERIOD.—Determina-
tions under this subsection shall be effective for 
a period determined appropriate by the Sec-
retary. 
‘‘(d) NO EFFECT ON PAYMENT TO PROVIDERS OF 
SERVICES
OR SUPPLIERS.—Notwithstanding any other 
provision of this title, in the case of an item or service 
for which the reduction in coinsurance or copayment under 
subsection (a) applies, the amount of payment otherwise 
applicable for the item or service under part A or B shall 
be increased by the amount of the reduction in coinsur-
ance or copayment under such subsection.’’. 
(b) DISCLOSURE.—Section 6103(l)(7)(D)(ii) of the 
Internal Revenue Code of 1986 is amended— 
(1) by striking ‘‘or subsidies’’ and inserting ‘‘, 
subsidies’’; and 
(2) by inserting ‘‘, or reduced cost-sharing pro-
vided under section 1899D’’ before the period at the 
end. 
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SEC. 5. ELIMINATING THE 24-MONTH WAITING PERIOD FOR 
MEDICARE COVERAGE FOR DISABLED INDI-
VIDUALS. 
(a) IN GENERAL.—Section 226(b) of the Social Secu-
rity Act (42 U.S.C. 426(b)) is amended— 
(1) in paragraph (2)(A), by striking ‘‘, and has 
for 24 calendar months been entitled to,’’; 
(2) in paragraph (2)(B), by striking ‘‘, and has 
been for not less than 24 months,’’; 
(3) in paragraph (2)(C)(ii), by striking ‘‘, in-
cluding the requirement that he has been entitled to 
the specified benefits for 24 months,’’; 
(4) in the first sentence, by striking ‘‘for each 
month beginning with the later of (I) July 1973 or 
(II) the twenty-fifth month of his entitlement or sta-
tus as a qualified railroad retirement beneficiary de-
scribed in paragraph (2), and’’ and inserting ‘‘for 
each month for which the individual meets the re-
quirements of paragraph (2), beginning with the 
month following the month in which the individual 
meets the requirements of such paragraph, and’’; 
and 
(5) in the second sentence, by striking ‘‘the 
‘twenty-fifth month of his entitlement’ ’’ and all that 
follows through ‘‘paragraph (2)(C) and’’. 
(b) CONFORMING AMENDMENTS.— 
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(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to insurance benefits under title 
XVIII of the Social Security Act with respect to items and 
services furnished in months beginning after December 
2017. 
SEC. 6. IMPROVING MEDICARE BENEFICIARY ENROLL-
MENT PROCEDURES AND EFFECTIVE DATES 
OF COVERAGE. 
(a) 
GENERAL
ENROLLMENT
PERIOD.—Section 
1837(e) of the Social Security Act (42 U.S.C. 1395p(e)) 
is amended to read as follows: 
‘‘(e) GENERAL AND SPECIAL ENROLLMENT PERI-
ODS.— 
‘‘(1) GENERAL ENROLLMENT.— 
‘‘(A) FOR COVERAGE DURING YEARS BE-
FORE 2018.—There shall be a general enroll-
ment period during the period beginning on 
January 1 and ending on March 31 of each 
year before 2018. 
‘‘(B) FOR COVERAGE DURING YEARS BE-
GINNING WITH 2018.—Subject to subparagraph 
(B), there shall be a general enrollment period 
beginning on October 15 and ending on Decem-
ber 31 of 2017 and each subsequent year. 
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‘‘(ii) pursuant to such subsection (d) in the 
month following such month in which he first 
satisfies such paragraph, the first day of the 
second month following the month in which he 
so enrolls, or 
‘‘(iii) pursuant to such subsection (d) more 
than one month following such month in which 
he satisfies such paragraph, the first day of the 
third month following the month in which he so 
enrolls, or 
‘‘(C) in the case of an individual not described 
in subparagraph (A) who enrolls pursuant to sub-
section (e) of section 1837 in a month beginning— 
‘‘(i) before April 1, 2017, the July 1 fol-
lowing the month in which he so enrolls, or 
‘‘(ii) on or after October 1, 2017, the first 
day of the month following the month in which 
he so enrolls, or 
‘‘(D) in the case of an individual not described 
in subparagraph (A) who first satisfies such para-
graph in a month beginning on or after January 1, 
2018, and who enrolls pursuant to such subsection 
(d) in such month in which he first satisfies such 
paragraph or in any subsequent month in the initial 
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enrollment period, the first day of the month fol-
lowing the month in which he so enrolls; or’’; and 
(B) in paragraph (3), by striking ‘‘sub-
paragraphs (B), (C), (D), and (E) of paragraph 
(2) of this subsection’’ and inserting ‘‘subpara-
graphs (B) and (C) of paragraph (2), as appli-
cable’’. 
(2) TECHNICAL CORRECTION.—Section 1839(b) 
of the Social Security Act (42 U.S.C. 1395r(b)) is 
amended, in the second sentence, by striking ‘‘close 
of the enrollment period’’ each place it appears and 
inserting ‘‘close of the month’’. 
(c) APPLICATION OF THE PART A LATE ENROLL-
MENT PENALTY TIME LIMITATION PROVISION TO THE 
PART B LATE ENROLLMENT PENALTY.— 
(1) IN GENERAL.—Section 1839(b) of the So-
cial Security Act (42 U.S.C. 1395r(b)) is amended 
by adding at the end the following new sentence: 
‘‘Any percent increase in an individual’s monthly 
premium under the first sentence shall only apply to 
premiums paid during a period equal to twice the 
number of months in the full 12-month periods de-
scribed in the first sentence.’’. 
(2) CONFORMING AMENDMENT TO THE PART A 
LATE ENROLLMENT PENALTY.—Section 1818(c)(6) 
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of the Social Security Act (42 U.S.C. 1395i–2(c)(6)) 
is amended by striking ‘‘and shall only apply to pre-
miums paid during a period equal to twice the num-
ber of months in the full 12-month periods described 
in that section’’. 
(3) EFFECTIVE DATE.— 
(A) IN GENERAL.—The amendments made 
by this section shall take effect on the date of 
the enactment of this Act and shall apply to 
premiums for months beginning on or after 
January 1, 2018. 
(B) COUNTING OF MONTHS.—In applying 
the amendment made by paragraph (1), months 
(occurring before, during, or after the month 
that includes the date of the enactment of this 
Act) in which an individual’s monthly premium 
is increased under subsection (b) of section 
1839 of the Social Security Act (42 U.S.C. 
1395r) shall be taken into account in deter-
mining whether the limitation under the last 
sentence of such subsection (b), as added by 
paragraph (1), is applicable. 
(d) APPLICATION OF PART B DEEMED ENROLLMENT 
PROCESS TO RESIDENTS OF PUERTO RICO; SPECIAL EN-
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ROLLMENT PERIOD AND LIMIT ON LATE ENROLLMENT 
PENALTIES.— 
(1) APPLICATION OF PART B DEEMED ENROLL-
MENT PROCESS TO RESIDENTS OF PUERTO RICO.— 
Section 1837(f)(3) of the Social Security Act (42 
U.S.C. 1395p(f)(3)) is amended by striking ‘‘, exclu-
sive of Puerto Rico’’. 
(2) EFFECTIVE DATE.—The amendment made 
by paragraph (1) shall apply to individuals whose 
initial enrollment period under section 1837(d) of 
the Social Security Act begins on or after the first 
day of the effective month, specified by the Sec-
retary of Health and Human Services under section 
1839(j)(1)(C) of such Act, as added by subsection 
(c)(2). 
(3) TRANSITION PROVIDING SPECIAL ENROLL-
MENT PERIOD AND LIMIT ON LATE ENROLLMENT 
PENALTIES
FOR
CERTAIN
MEDICARE
BENE-
FICIARIES.—Section 1839 of the Social Security Act 
(42 U.S.C. 1395r) is amended— 
(A) in the first sentence of subsection (b), 
by inserting ‘‘subject to section 1839(j)(2),’’ 
after ‘‘subsection (i)(4) or (l) of section 1837,’’; 
and 
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(B) by adding at the end the following new 
subsection: 
‘‘(j) SPECIAL RULES FOR CERTAIN RESIDENTS OF 
PUERTO RICO.— 
‘‘(1) SPECIAL ENROLLMENT PERIOD, COVERAGE 
PERIOD FOR RESIDENTS WHO ARE ELIGIBLE BUT 
NOT ENROLLED.— 
‘‘(A) IN GENERAL.—In the case of a tran-
sition individual (as defined in paragraph (3)) 
who is not enrolled under this part as of the 
day before the first day of the effective month 
(as defined in subparagraph (C)), the Secretary 
shall provide for a special enrollment period 
under section 1837 of 7 months beginning with 
such effective month during which the indi-
vidual may be enrolled under this part. 
‘‘(B) COVERAGE PERIOD.—In the case of 
such an individual who enrolls during such spe-
cial enrollment period, the coverage period 
under section 1838 shall begin on the first day 
of the second month after the month in which 
the individual enrolls. 
‘‘(C) EFFECTIVE
MONTH
DEFINED.—In 
this section, the term ‘effective month’ means a 
month, not earlier than October 2017 and not 
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later than January 2018, specified by the Sec-
retary. 
‘‘(2) REDUCTION IN LATE ENROLLMENT PEN-
ALTIES
FOR
CURRENT
ENROLLEES
AND
INDIVID-
UALS ENROLLING DURING TRANSITION.— 
‘‘(A) IN GENERAL.—In the case of a tran-
sition individual who is enrolled under this part 
as of the day before the first day of the effec-
tive month or who enrolls under this part on or 
after the date of the enactment of this sub-
section but before the end of the special enroll-
ment period under paragraph (1)(A), the 
amount of the late enrollment penalty imposed 
under section 1839(b) shall be recalculated by 
reducing the penalty to 15 percent of the pen-
alty otherwise established. 
‘‘(B) APPLICATION.—Subparagraph (A) 
shall be applied in the case of a transition indi-
vidual who— 
‘‘(i) is enrolled under this part as of 
the month before the effective month, for 
premiums for months beginning with such 
effective month; or 
‘‘(ii) enrolls under this part on or 
after the date of the enactment of this Act 
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and before the end of the special enroll-
ment period under paragraph (1)(A), for 
premiums for months during the coverage 
period under this part which occur during 
or after the effective month. 
‘‘(C) LOSS OF REDUCTION IF INDIVIDUAL 
TERMINATES
ENROLLMENT.—Subparagraph 
(A) shall not apply to a transition individual if 
the individual terminates enrollment under this 
part after the end of the special enrollment pe-
riod under paragraph (1). 
‘‘(3) TRANSITION
INDIVIDUAL
DEFINED.—In 
this section, the term ‘transition individual’ means 
an individual who resides in Puerto Rico and who 
would have been deemed enrolled under this part 
pursuant to section 1837(f) before the first day of 
the effective month but for the fact that the indi-
vidual was a resident of Puerto Rico, regardless of 
whether the individual is enrolled under this part as 
of such first day.’’. 
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SEC. 7. ELIMINATING EXCLUSION OF PART D ELIGIBLE IN-
DIVIDUALS RESIDING IN TERRITORIES FROM 
ELIGIBILITY FOR PREMIUM AND COST-SHAR-
ING SUBSIDIES. 
(a) IN GENERAL.—Section 1860D–14(a)(3) of the 
Social Security Act (42 U.S.C. 1395w–114(a)(3)), as 
amended by section 3(d), is amended— 
(1) in subparagraph (A), in the matter pre-
ceding clause (i), by striking ‘‘subject to subpara-
graph (E),’’; 
(2) in subparagraph (B)(v), in the matter pre-
ceding subclause (I), by striking ‘‘Subject to sub-
paragraph (E), the Secretary’’ and inserting ‘‘The 
Secretary’’; 
(3) in subparagraph (C), by adding at the end 
the following new sentence: ‘‘In the case of an indi-
vidual who is not a resident of the 50 States or the 
District of Columbia, the poverty line (as such term 
is defined in clause (ii)) that shall apply to such in-
dividual shall be the poverty line for the 48 contig-
uous States and the District of Columbia.’’; 
(4) by striking subparagraph (E), as redesig-
nated by section 3(d)(1); and 
(5) by redesignating subparagraphs (F) and 
(G), as added by section 3(d)(2), as subparagraphs 
(E) and (F), respectively. 
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(b) APPLICATION OF MEDICAID PROVISIONS.—Sec-
tion 1935 of the Social Security Act (42 U.S.C. 1396u– 
5) is amended— 
(1) in subsection (a), by striking ‘‘subject to 
subsection (e)’’ in the matter preceding paragraph 
(1); and 
(2) by striking subsection (e). 
(c) CONFORMING AMENDMENTS.— 
(1) Section 1108(f) of the Social Security Act 
(42 U.S.C. 1308(f)) is amended by striking ‘‘and 
section 1935(e)(1)(B)’’ in the matter preceding 
clause (i). 
(2) Section 1860D–14(a) of the Social Security 
Act (42 U.S.C. 1395w–114(a)), as amended by sec-
tion 3(d), is amended— 
(A) in paragraph (1), in the matter pre-
ceding subparagraph (A), by striking ‘‘subpara-
graph (3)(G)’’ and inserting ‘‘subparagraph 
(3)(F)’’; and 
(B) in paragraph (3)— 
(i) in subparagraph (A)(ii), by strik-
ing ‘‘subparagraph (G)’’ and inserting 
‘‘subparagraph (F)’’; and 
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(ii) in subparagraph (D)(i), by strik-
ing ‘‘subparagraph (F)’’ and inserting 
‘‘subparagraph (E)’’. 
(3) Section 1905 of the Social Security Act (42 
U.S.C. 1396d) is amended— 
(A) in subsection (p)— 
(i) in paragraph (1)(C), by striking 
‘‘subparagraph (F)’’ and inserting ‘‘sub-
paragraph (E)’’; and 
(ii) in clause (iii) of paragraph (2)(D), 
as added by section 3(e)(2)(A)(ii), by strik-
ing ‘‘section 1860D–14(a)(3)(G)’’ and in-
serting ‘‘section 1860D–14(a)(3)(F)’’; and 
(B) in subsection (s)— 
(i) in paragraph (2), by striking ‘‘sec-
tion 1860D–14(a)(3)(G)’’ and inserting 
‘‘section 1860D–14(a)(3)(F)’’; and 
(ii) in paragraph (3), by striking 
‘‘subparagraph (F)’’ and inserting ‘‘sub-
paragraph (E)’’. 
(d) EFFECTIVE DATE.—The amendments made by 
this section shall take effect on January 1, 2017. 
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SEC. 8. EXTENDING FUNDING FOR LOW-INCOME MEDICARE 
BENEFICIARY OUTREACH AND ASSISTANCE 
EDUCATION ACTIVITIES. 
(a) ADDITIONAL FUNDING FOR STATE HEALTH IN-
SURANCE PROGRAMS.—Section 119 of the Medicare Im-
provements for Patients and Providers Act of 2008 (42 
U.S.C. 1395b–3 note), as amended by section 3306 of the 
Patient Protection and Affordable Care Act (Public Law 
111–148), section 610 of the American Taxpayer Relief 
Act of 2012 (Public Law 112–240), section 1110 of the 
Pathway for SGR Reform Act of 2013 (Public Law 113– 
67), section 110 of the Protecting Access to Medicare Act 
of 2014 (Public Law 113–93), and section 208 of the 
Medicare Access and CHIP Reauthorization Act of 2015 
(Public Law 114–10) is amended— 
(1) in subsection (a)(1)(B)— 
(A) in clause (vi), by striking ‘‘and’’ at the 
end; 
(B) in clause (vii), by striking the period 
at the end and inserting ‘‘; and’’; and 
(C) by inserting after clause (vii) at the 
end the following new clause: 
‘‘(viii) for fiscal year 2018 and each 
subsequent year, of the amount transferred 
under this subparagraph for the preceding 
fiscal year, increased by the percentage in-
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crease determined under subsection (h) for 
the fiscal year.’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(h) For purposes of subsections (a)(1)(B)(viii), 
(b)(1)(B)(viii), (c)(1)(B)(viii), and (d)(2)(viii), the per-
centage increase determined under this subsection for a 
fiscal year is equal to the sum of the— 
‘‘(1) the percentage increase in the consumer 
price index for all urban consumers (all items; 
United States city average) for the 12-month period 
ending with July preceding the beginning of the fis-
cal year; and 
‘‘(2) the percentage increase in the average 
number of individuals enrolled in part B of title 
XVIII of the Social Security Act, from the preceding 
fiscal year to such fiscal year, as estimated by the 
Chief Actuary of the Centers for Medicare & Med-
icaid Services.’’. 
(b) ADDITIONAL FUNDING FOR AREA AGENCIES ON 
AGING.—Subsection (b)(1)(B) of such section 119, as so 
amended, is amended— 
(1) in clause (vi), by striking ‘‘and’’ at the end; 
(2) in clause (vii), by striking the period at the 
end and inserting ‘‘; and’’; and 
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(3) by inserting after clause (vii) the following 
new clause: 
‘‘(viii) for fiscal year 2018 and each 
subsequent year, of the amount transferred 
under this subparagraph for the preceding 
fiscal year, increased by the percentage in-
crease determined under subsection (h) for 
the fiscal year.’’. 
(c) ADDITIONAL FUNDING
FOR AGING
AND DIS-
ABILITY RESOURCE CENTERS.—Subsection (c)(1)(B) of 
such section 119, as so amended, is amended— 
(1) in clause (vi), by striking ‘‘and’’ at the end; 
(2) in clause (vii), by striking the period at the 
end and inserting ‘‘; and’’; and 
(3) by inserting after clause (vii) the following 
new clauses: 
‘‘(viii) for fiscal year 2018 and each 
subsequent year, of the amount transferred 
under this subparagraph for the preceding 
fiscal year, increased by the percentage in-
crease determined under subsection (h) for 
the fiscal year.’’. 
(d) ADDITIONAL FUNDING
FOR CONTRACT WITH 
THE NATIONAL CENTER FOR BENEFITS AND OUTREACH 
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ENROLLMENT.—Subsection (d)(2) of such section 119, as 
so amended, is amended— 
(1) in clause (vi), by striking ‘‘and’’ at the end; 
(2) in clause (vii), by striking the period at the 
end and inserting ‘‘; and’’; 
(3) by inserting after clause (vii) the following 
new clause: 
‘‘(viii) for fiscal year 2018 and each 
subsequent year, of the amount transferred 
under this paragraph for the preceding fis-
cal year, increased by the percentage in-
crease determined under subsection (h) for 
the fiscal year.’’; and 
(4) in the flush sentence at the end, by striking 
‘‘subparagraph’’ and inserting ‘‘paragraph’’. 
Æ 
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