316 
Health Service, including as a California In-
dian, Eskimo, Aleut, or other Alaska Native.’’. 
(b) CONFORMING AMENDMENTS.— 
(1) AFFORDABLE
CHOICES
HEALTH
BENEFIT 
PLANS.—Section 1311(c)(6)(D) of the Patient Pro-
tection and Affordable Care Act (42 U.S.C. 
18031(c)(6)(D)) is amended by striking ‘‘(as defined 
in section 4 of the Indian Health Care Improvement 
Act)’’. 
(2) REDUCED COST-SHARING FOR INDIVIDUALS 
ENROLLING IN QUALIFIED HEALTH PLANS.—Section 
1402(d) of the Patient Protection and Affordable 
Care Act (42 U.S.C. 18071(d)) is amended— 
(A) in paragraph (1), in the matter pre-
ceding subparagraph (A), by striking ‘‘(as de-
fined in section 4(d) of the Indian Self-Deter-
mination and Education Assistance Act (25 
U.S.C. 450b(d))’’; and 
(B) in paragraph (2), in the matter pre-
ceding subparagraph (A), by striking ‘‘(as so 
defined)’’. 
(3) EXEMPTION
FROM
PENALTY
FOR
NOT 
MAINTAINING
MINIMUM
ESSENTIAL
COVERAGE.— 
Section 5000A(e) of the Internal Revenue Code of 
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317 
1986 is amended by striking paragraph (3) and in-
serting the following: 
‘‘(3) INDIANS.—Any applicable individual who 
is an Indian (as defined in section 1304(f) of the 
Patient Protection and Affordable Care Act).’’. 
(c) EFFECTIVE DATE
OF IRC PROVISION.—The 
amendment made by subsection (b)(3) shall apply to tax-
able years beginning after the date of the enactment of 
this section. 
SEC. 4105. REMOVING MEDICARE BARRIER TO HEALTH 
CARE. 
(a) PART A.—Section 1818(a)(3) of the Social Secu-
rity Act (42 U.S.C. 1395i–2(a)(3)) is amended by striking 
‘‘an alien’’ and all that follows through ‘‘under this sec-
tion’’ and inserting ‘‘an individual who is lawfully present 
in the United States’’. 
(b) PART B.—Section 1836(2) of the Social Security 
Act (42 U.S.C. 1395o(2)) is amended by striking ‘‘an 
alien’’ and all that follows through ‘‘under this part’’ and 
inserting ‘‘an individual who is lawfully present in the 
United States’’. 
SEC. 4106. LOWERING MEDICARE PREMIUMS AND PRE-
SCRIPTION DRUG COSTS. 
(a) MEDICARE COST ASSISTANCE PROGRAM.— 
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(1) IN GENERAL.—Title XVIII of the Social Se-
curity Act (42 U.S.C. 1395 et seq.) is amended by 
adding at the end the following new section: 
‘‘SEC. 1899C. 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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319 
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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322 
‘‘(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 based 
on culturally fluid language for all demo-
graphics beyond just the various languages 
offered. An audio version, digital version 
and photo-voice option should also be pro-
vided for all learners. The Secretary shall 
provide for the translation of such applica-
tion 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 Se-
curity. 
‘‘(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-
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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 
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 
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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 
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. 
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‘‘(f) OUTREACH EFFORTS.—For provisions relating 
to outreach efforts to increase awareness of the availability 
of Medicare cost assistance, see section 1144.’’. 
(2) SPECIAL ENROLLMENT PERIOD.— 
(A) 
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 following before the period: ‘‘or, 
effective beginning January 1, 2023, for indi-
viduals who are Medicare Cost Assistance Pro-
gram eligible individuals (as defined in section 
1899B(b)(1)).’’. 
(B) SPECIAL ENROLLMENT PERIOD.—Sec-
tion 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 
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