(11) INDIVIDUALS AT RISK FOR DIABETES.— 
Section 1861(yy)(2)(F)(iv) of such Act (42 U.S.C. 
1395x(yy)(2)(F)(iv)) is amended by striking ‘‘65’’ 
and inserting ‘‘60’’. 
(12) EXCLUSIONS FROM COVERAGE AND MEDI-
CARE
AS
A
SECONDARY
PAYER.—Section 
1862(b)(1)(A)(i)(II) 
of 
such 
Act 
(42 
U.S.C. 
1395y(b)(1)(A)(i)(II)) is amended by striking ‘‘65’’ 
each place it appears and inserting ‘‘60’’. 
(13) CERTIFICATION
OF
MEDICARE
SUPPLE-
MENTAL
HEALTH
INSURANCE
POLICIES.—Section 
1882(s) of such Act (42 U.S.C. 1395ss(s)) is 
amended— 
(A) in paragraph (2)— 
(i) in subparagraph (A), by striking 
‘‘65 years of age or older’’ and inserting 
‘‘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,’’; 
and 
(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 
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the Improving Medicare Coverage Act) or 
60 years of age or older (in the case of an 
individual who did not attain the age of 65 
before the date that is 6 months after such 
date of enactment)’’ after ‘‘older’’; and 
(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 Im-
proving Medicare Coverage Act) or 60 
years of age or older (in the case of an in-
dividual who did not attain the age of 65 
before the date that is 6 months after such 
date of enactment)’’ after ‘‘older’’; and 
(ii) in clause (vi), by striking ‘‘eligible 
for benefits under part A at age 65’’ and 
inserting ‘‘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)) is amended 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 Cov-
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erage Act or age 60 (in the case of an individual 
who did not attain the age of 65 before the date that 
is 6 months after such date of enactment)’’ after 
‘‘65’’. 
(15) MEDICARE SUBVENTION DEMONSTRATION 
PROJECT
FOR
MILITARY
RETIREES.—Section 
1896(a)(4) of such Act (42 U.S.C. 1395ggg(a)(4)) is 
amended— 
(A) in subparagraph (B)— 
(i) in clause (i), by striking ‘‘benefits 
under part A of this title’’ and inserting 
‘‘part A benefits under section 226(a)’’; 
and 
(ii) in clause (ii), by striking the semi-
colon at the end and inserting ‘‘; and’’; 
(B) in subparagraph (C), by striking ‘‘; 
and’’ and inserting a period; and 
(C) by striking subparagraph (D). 
(d) ELIGIBILITY FOR PREMIUM ASSISTANCE.—Cov-
erage 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 
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the individual resides for purposes of section 36B of the 
Internal Revenue Code of 1986 other than subsection 
(c)(2)(B) thereof. 
(e) AUTOMATIC ENROLLMENT OF INDIVIDUALS EN-
TITLED
TO PART A.—The Secretary of Health and 
Human Services shall establish procedures to provide for 
the automatic enrollment of individuals who become enti-
tled 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 individ-
uals 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 DE-
PENDENTS.—Nothing in this section shall be construed 
to— 
(1) provide coverage under the Medicare pro-
gram 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. 
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(g) CLARIFICATION OF MEDICARE AS SECONDARY 
PAYER.—Nothing in this section shall affect the require-
ments under section 1862(b) of the Social Security Act 
(42 U.S.C. 1395y(b)) (relating to Medicare as secondary 
payer). 
(h) EFFECTIVE DATE.— 
(1) IN GENERAL.—Subject to paragraph (2), 
the amendments made by this section shall take ef-
fect 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 ef-
fect on the date of enactment of this Act. 
SEC. 3. 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 on the date 
that is 6 months after the date of the enactment of the 
Improving Medicare Coverage Act, in the case of a Medi-
care Cost Assistance Program eligible individual (as de-
fined in subsection (b)(1)), the Secretary shall provide 
Medicare cost assistance for the following costs incurred 
with respect to the individual: 
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‘‘(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-
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 the day prior to the date 
that is 6 months after the date of the enact-
ment of the Improving Medicare Coverage Act; 
or 
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‘‘(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 
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 
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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 
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 
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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); 
‘‘(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 
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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 
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 
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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 
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 
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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 
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. 
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for individuals who are Medicare Cost Assistance 
Program eligible individuals (as defined 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 on the 
date that is 6 months after the date of the enact-
ment of the Improving Medicare Coverage Act, the 
Secretary shall establish special enrollment periods 
for Medicare Cost Assistance Program eligible indi-
viduals (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 
‘‘(B) remain in effect until such time as 
the Secretary determines the individual no 
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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 the date that is 6 months after the date of the enact-
ment of the Improving Medicare Coverage Act.’’. 
(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 MEDI-
CARE 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) 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 2022 through 2024, 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. 4. 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 the date that is 6 months after the date 
of the enactment of the Improving Medicare Cov-
erage Act,’’ before ‘‘for making’’ each place it ap-
pears 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 the date that is 
6 months after the date of the enactment of the 
Improving Medicare Coverage Act’’ after ‘‘(de-
scribed 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-
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able after the date that is 6 months after the 
date of the enactment of the Improving Medi-
care Coverage Act’’ before the semicolon at the 
end. 
(b) CONFORMING AMENDMENTS.— 
(1) TITLE XIX.— 
(A) Section 1903(i) of such Act (42 U.S.C. 
1396b(i)) is amended— 
(i) in paragraph (26), by striking ‘‘; 
and’’ and inserting a semicolon; 
(ii) in paragraph (27), by striking the 
period at the end and inserting ‘‘; and’’; 
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 de-
scribed in section 1905(s)) furnished during cal-
endar 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)) is amended, in the first sen-
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tence, 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’’ after ‘‘medi-
care cost-sharing’’. 
(C) Section 1933(g) of such Act (42 
U.S.C. 1396u–3(g)) is amended— 
(i) in paragraph (2)(Q), by striking 
‘‘paragraph (4), for each subsequent year’’ 
and inserting ‘‘paragraphs (4) and (5), for 
each subsequent year (prior to the date 
that is 6 months after the date of the en-
actment of the Improving Medicare Cov-
erage Act’’; and 
(ii) by adding at the end the fol-
lowing: 
‘‘(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 en-
actment of the Improving Medicare Coverage Act, 
and no State allocation shall be made for any fiscal 
year or period under this section beginning on or 
after the date that is 6 month after such date of en-
actment.’’. 
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