I 
117TH CONGRESS 
1ST SESSION H. R. 5099 
To amend title XVIII of the Social Security Act to move Medicare cost- 
sharing benefits from Medicaid to Medicare, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
AUGUST 24, 2021 
Mr. SCHNEIDER (for himself and Ms. SCHAKOWSKY) introduced the following 
bill; which was referred to the Committee on Energy and Commerce, and 
in addition to the Committee on Ways and Means, for a period to be sub-
sequently determined by the Speaker, in each case for consideration of 
such provisions as fall within the jurisdiction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to move 
Medicare cost-sharing benefits from Medicaid to Medi-
care, 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. 
This Act may be cited as the ‘‘Lowering Medicare 
Premiums and Prescription Drug Costs Act’’. 
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SEC. 2. MEDICARE COST ASSISTANCE PROGRAM. 
(a) IN GENERAL.—Title XVIII of the Social Security 
Act (42 U.S.C. 1395 et seq.) is amended by adding at 
the end the following new section: 
‘‘SEC. 1899B. MEDICARE COST ASSISTANCE PROGRAM. 
‘‘(a) IN GENERAL.—Effective beginning January 1, 
2023, in the case of a Medicare Cost Assistance Program 
eligible individual (as defined in subsection (b)(1)), the 
Secretary shall provide Medicare cost assistance for the 
following costs incurred with respect to the individual: 
‘‘(1)(A) premiums under section 1818; and 
‘‘(B) premiums under section 1839. 
‘‘(2) Coinsurance under this title (including co-
insurance described in section 1813). 
‘‘(3) Deductibles established under this title (in-
cluding 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 ‘Medi-
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care Cost Assistance Program eligible individual’ 
means an individual who— 
‘‘(A) is eligible for and is receiving medical 
assistance for the payment of medicare cost- 
sharing under a State Medicaid program pursu-
ant to clause (i), (iii), or (iv) of section 
1902(a)(10)(E) as of December 31, 2022; or 
‘‘(B)(i) is entitled to hospital insurance 
benefits under part A (including an individual 
entitled to such benefits pursuant to an enroll-
ment 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 As-
sistance Program eligible individual described in 
paragraph (1) shall be determined by the Com-
missioner of Social Security jointly with the de-
termination of whether an individual is a sub-
sidy eligible individual described in section 
1860D–14(a)(3). Such determination shall be 
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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 ei-
ther 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.—Determina-
tions under this paragraph with respect to eligi-
bility for each of such assistance or such sub-
sidies shall be effective beginning with the 
month in which the individual applies for a de-
termination 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 para-
graph— 
‘‘(i) redeterminations shall be made at 
the same time with respect to eligibility for 
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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 automati-
cally determine that an individual remains 
eligible for such assistance or subsidies un-
less— 
‘‘(I) the Commissioner has infor-
mation 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 no-
tice to the individual regarding such 
information that requests a response 
either confirming or correcting such 
information; and 
‘‘(III) the individual either con-
firms such information or fails to pro-
vide documentation indicating that 
such circumstances have not changed 
within 60 days of receiving the notice 
described in subclause (II); 
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‘‘(iii) the Commissioner shall establish 
procedures for appeals of such determina-
tions that are similar to the procedures de-
scribed in the third sentence of section 
1631(c)(1)(A); and 
‘‘(iv) judicial review of the final deci-
sion of the Commissioner made after a 
hearing shall be available to the same ex-
tent, and with the same limitations, as pro-
vided in subsections (g) and (h) of section 
205. 
‘‘(D) TREATMENT
OF
MEDICAID
BENE-
FICIARIES.—The Secretary shall provide that 
individuals who are full-benefit dual eligible in-
dividuals (as defined in section 1935(c)(6)) or 
who are recipients of supplemental security in-
come 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 eli-
gible individual, a subsidy eligible individual de-
scribed in section 1860D–14(a)(3). 
‘‘(E) SIMPLIFIED APPLICATION FORM.— 
‘‘(i) IN
GENERAL.—The Secretary 
shall develop and distribute a simplified 
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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 ap-
plicants and uniform nationally. The Sec-
retary 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 So-
cial 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 Pro-
gram eligible individual or a subsidy eligible in-
dividual under paragraph (2)(D), income shall 
be determined in the manner described under 
section 1612 for purposes of the supplemental 
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security income program, except that support 
and maintenance furnished in kind shall not be 
counted as income; and 
‘‘(B) the term ‘poverty line’ has the mean-
ing given such term in section 673(2) of the 
Community Services Block Grant Act (42 
U.S.C. 9902(2)), including any revision re-
quired by such section. 
‘‘(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 re-
spect 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 sanc-
tion 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 indi-
vidual in such case. 
‘‘(2) CLARIFICATION.—This paragraph shall 
not be construed as preventing payment of any 
medicare cost assistance by a medicare supplemental 
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policy or an employer retiree health plan on behalf 
of an individual. 
‘‘(d) ADMINISTRATION.— 
‘‘(1) IN GENERAL.—The Secretary shall estab-
lish procedures for the administration of the pro-
gram 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 Med-
ical Insurance Trust Fund under section 1841, in 
such proportion as the Secretary determines appro-
priate, of such amounts as the Secretary determines 
necessary to provide Medicare cost assistance under 
this section. 
‘‘(e) REFERENCES TO MEDICARE COST-SHARING.— 
Effective beginning January 1, 2023, any reference to 
medicare cost-sharing described in section 1905(p) shall 
be deemed a reference to Medicare cost assistance under 
this section. 
‘‘(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.— 
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(1) NO PREMIUM PENALTY.—Section 1839(b) 
of the Social Security Act (42 U.S.C. 1395r(b)) is 
amended, in the last sentence, by inserting the fol-
lowing before the period: ‘‘or, effective beginning 
January 1, 2023, for individuals who are Medicare 
Cost Assistance Program eligible individuals (as de-
fined in section 1899B(b)(1)).’’. 
(2) SPECIAL
ENROLLMENT
PERIOD.—Section 
1837 of the Social Security Act (42 U.S.C. 1395p) 
is amended by adding at the end the following new 
subsection: 
‘‘(o) SPECIAL ENROLLMENT PERIOD FOR MEDICARE 
COST ASSISTANCE PROGRAM ELIGIBLE INDIVIDUAL.— 
‘‘(1) IN GENERAL.—Effective beginning Janu-
ary 1, 2023, the Secretary shall establish special en-
rollment periods for Medicare Cost Assistance Pro-
gram eligible individuals (as defined in section 
1899B(b)(1)). 
‘‘(2) COVERAGE PERIOD.—In the case of an in-
dividual 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 de-
termination under section 1899B(b)(2)(A); and 
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‘‘(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
AGREE-
MENTS RELATING TO ENROLLMENT OF QUALIFIED 
MEDICARE BENEFICIARIES.— 
(A) PART A.—Section 1818(g) of the So-
cial Security Act (42 U.S.C. 1395i–2(g)) is 
amended by adding at the end the following 
new paragraph: 
‘‘(3) SUNSET.—This subsection shall not apply 
on or after January 1, 2023.’’. 
(B) PART B.—Section 1843(h) of the So-
cial Security Act (42 U.S.C. 1395v(h)) is 
amended by adding at the end the following 
new paragraph: 
‘‘(3) SUNSET
WITH
RESPECT
TO
QUALIFIED 
MEDICARE
BENEFICIARIES.—This subsection shall 
not apply with respect to qualified medicare bene-
ficiaries on or after January 1, 2023.’’. 
(c) PUBLIC AWARENESS CAMPAIGN.—Section 1144 
of the Social Security Act (42 U.S.C. 1320b–14) is 
amended by adding at the end the following new sub-
section: 
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‘‘(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 sec-
tion 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 sec-
tion 119 of the Medicare Improvements for Patients 
and Providers Act of 2008 (42 U.S.C. 1395b–3 
note)), the Administrator of the Administration for 
Community Living, and the Administrator of the 
Centers for Medicare & Medicaid Services. 
‘‘(3) FUNDING.—There are hereby appropriated 
to the Commissioner, out of any funds in the Treas-
ury not otherwise appropriated, $10,000,000 for 
each of fiscal years 2023 through 2025, to provide 
grants to State health insurance assistance pro-
grams to carry out outreach and education activities 
under the public awareness campaign pursuant to 
this subsection.’’. 
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SEC. 3. MOVING MEDICARE COST-SHARING BENEFITS 
FROM MEDICAID TO MEDICARE. 
(a) ENDING MOST MEDICARE COST-SHARING BENE-
FITS UNDER MEDICAID.—Section 1902(a)(10) of the So-
cial Security Act (42 U.S.C. 1396a(a)(10)) is amended— 
(1) by inserting ‘‘for calendar quarters begin-
ning before January 1, 2023,’’ before ‘‘for making’’ 
each place it appears in clauses (i), (iii), and (iv) of 
subparagraph (E); and 
(2) in the matter following subparagraph (G)— 
(A) by inserting ‘‘furnished during cal-
endar quarters beginning before January 1, 
2023’’ 
after 
‘‘(described 
in 
section 
1905(p)(3))’’; 
(B) by striking ‘‘(XV)’’ and inserting ‘‘, 
(XV)’’; 
(C) by striking ‘‘and (XVIII)’’ and insert-
ing ‘‘, (XVIII)’’; and 
(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 de-
scribed in section 1905(s), shall be made avail-
able after January 1, 2023’’ before the semi-
colon at the end. 
(b) CONFORMING AMENDMENTS.— 
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(I) 
by 
striking 
‘‘sections 
1902(a)(10)(E) and 1933’’ and in-
serting ‘‘section 1902(a)(10)(E) and 
(prior to January 1, 2023) section 
1933’’; 
(II) by striking ‘‘for the transi-
tional 
assistance 
under 
section 
1860D–31(f), or’’ and inserting a 
comma; and 
(III) by inserting ‘‘, or for Medi-
care premium and cost-sharing assist-
ance under section 1899B (in the case 
of months beginning on or after Janu-
ary 1, 2023)’’ before the semicolon; 
and 
(ii) by striking paragraph (2) and in-
serting the following: 
‘‘(2) CONTENT
OF
NOTICE.—Any notice fur-
nished under paragraph (1) shall state that eligi-
bility for such medical assistance, subsidies, or pro-
gram is conditioned upon meeting the applicable eli-
gibility criteria.’’; 
(B) in subsection (b)(1)(A)— 
(i) 
by 
striking 
‘‘sections 
1902(a)(10)(E) and 1933’’ and inserting 
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‘‘section 1902(a)(10)(E) and (prior to Jan-
uary 1, 2023) section 1933’’; 
(ii) by striking ‘‘for transitional as-
sistance under section 1860D–31(f), or’’; 
and 
(iii) by inserting ‘‘, or for Medicare 
premium and cost-sharing assistance under 
section 1899B’’ before the semicolon; and 
(C) in subsection (c)— 
(i) in paragraph (1)(B), by inserting 
‘‘, and (beginning January 1, 2023,) pro-
vide an application for enrollment under 
the Medicare Savings Program’’ before the 
period; 
(ii) in paragraph (2), in the para-
graph header, by inserting ‘‘MEDICARE 
SAVINGS PROGRAM APPLICATION AND’’ be-
fore ‘‘LIS APPLICATION’’; and 
(iii) in paragraph (7), by striking 
‘‘means the program of medical assist-
ance’’ and all that follows through the pe-
riod and inserting ‘‘means— 
‘‘(A) prior to January 1, 2023, the pro-
gram of medical assistance for payment of the 
cost of medicare cost-sharing under the Med-
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icaid 
program 
pursuant 
to 
sections 
1902(a)(10)(E) and 1933; and 
‘‘(B) beginning January 1, 2023, the pro-
gram for medical assistance for payment of the 
cost of medicare cost-sharing for qualified dis-
abled and working individuals described in sec-
tion 
1905(s) 
pursuant 
to 
section 
1902(a)(10)(E)(ii) and medicare premium and 
cost-sharing assistance provided under section 
1899B.’’. 
(c) ENSURING
THAT
MEDICARE
COST-SHARING 
BENEFICIARIES UNDER MEDICAID RECEIVE MEDICARE 
COST ASSISTANCE.—Not later than June 1, 2022, the 
Secretary of Health and Human Services and the Commis-
sioner of Social Security shall jointly develop and imple-
ment 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 Med-
icaid program pursuant to clauses (i), (iii), and (iv) of sec-
tion 1902(a)(10)(E) of the Social Security Act (42 U.S.C. 
1396a(a)(10)(E)) as of December 31, 2022, receive Medi-
care cost assistance under section 1899B of such Act, as 
added by section 2, as of January 1, 2023. 
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SEC. 4. ENHANCING PRESCRIPTION DRUG AFFORDABILITY 
BY EXPANDING ACCESS TO ASSISTANCE WITH 
OUT-OF-POCKET COSTS UNDER MEDICARE 
PART D FOR LOW-INCOME SENIORS AND IN-
DIVIDUALS WITH DISABILITIES. 
(a) EXPANDING ACCESS.—Section 1860D–14 of the 
Social Security Act (42 U.S.C. 1395w–114) is amended— 
(1) in subsection (a)— 
(A) in the heading, by striking ‘‘150 PER-
CENT’’ and inserting ‘‘200 PERCENT’’; 
(B) in paragraph (1)— 
(i) in the heading, by striking ‘‘135 
PERCENT’’ and inserting ‘‘200 PERCENT’’; 
and 
(ii) in the matter preceding subpara-
graph (A)— 
(I) by striking ‘‘135 percent’’ and 
inserting ‘‘200 percent’’; and 
(II) by striking ‘‘and who meets 
the resources requirement described in 
paragraph (3)(D) or who is covered 
under this paragraph under para-
graph (3)(B)(i)’’ and inserting ‘‘or 
who is covered under this paragraph 
under paragraph (3)(B)(v)’’; 
(C) by striking paragraph (2); 
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(D) in paragraph (3)— 
(i) in subparagraph (A)— 
(I) in clause (i), by adding ‘‘and’’ 
at the end; 
(II) in clause (ii)— 
(aa) by striking ‘‘150 per-
cent’’ and inserting ‘‘200 per-
cent’’; and 
(bb) by striking ‘‘; and’’ at 
the end and inserting a period; 
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 pur-
poses 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 
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eligible 
individual 
under 
section 
1899B(b)(2)(D), income shall be deter-
mined in the manner described under sec-
tion 1612 for purposes of the supplemental 
security income program, except that sup-
port and maintenance furnished in kind 
shall not be counted as income; and 
‘‘(ii) the term ‘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 re-
vision required by such section.’’. 
(iii) by striking subparagraphs (D), 
(E), and (G); and 
(E) in paragraph (4), by striking subpara-
graph (B); and 
(2) in subsection (c)(1), in the second sentence, 
by striking ‘‘subsections (a)(1)(D) and (a)(2)(E)’’ 
and inserting ‘‘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)) is 
amended— 
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