Lowering Medicare Premiums and Prescription Drug Costs Act
Bill: H.R.5099 | Sponsor: Rep. Schneider, Bradley Scott (D-IL)
Policy area: Health

Summary:
Lowering Medicare Premiums and Prescription Drug Costs Act
This bill transfers certain programs that provide Medicare premium and cost-sharing assistance for low-income individuals from Medicaid to Medicare.
Specifically, the bill 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.

To amend title XVIII of the Social Security Act to move Medicare cost-
  sharing benefits from Medicaid to Medicare, and for other purposes.

    Be it enacted by the Senate and House of Representatives 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''.

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 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' 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 pursuant 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 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' 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.
    ``(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 
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.--
            (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 following before the period: ``or, 
        effective beginning January 1, 2023, 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 January 1, 2023, the 
        Secretary shall establish special enrollment periods for 
        Medicare Cost Assistance Program eligible individuals (as 
        defined in section 1899B(b)(1)).
            ``(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)) 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 Social 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 beneficiaries 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 subsection:
    ``(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 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 Treasury not otherwise 
        appropriated, $10,000,000 for each of fiscal years 2023 through 
        2025, 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.''.

SEC. 3. 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)) 
is amended--
            (1) by inserting ``for calendar quarters beginning 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 calendar 
                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 inserting ``, 
                (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 described in 
                section 1905(s), shall be made available after January 
                1, 2023'' 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 described in section 1905(s)) furnished 
        during calendar quarters beginning on or after January 1, 
        2023.''.
                    (B) Section 1905(a) of such Act (42 U.S.C. 
                1396d(a)) is amended, in the first sentence, by 
                inserting ``furnished during calendar quarters 
                beginning before January 1, 2023'' after ``medicare 
                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 before 2023''; and
                            (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 January 1, 2023, and no 
        State allocation shall be made for any fiscal year or period 
        under this section beginning on or after January 1, 2023.''.
                    (D) Section 1935(a) of such Act (42 U.S.C. 1396u-
                5(a)) is amended--
                            (i) in paragraph (2), by striking ``make 
                        determinations'' and inserting ``prior to 
                        January 1, 2023, make determinations''; and
                            (ii) in paragraph (3), by inserting ``prior 
                        to January 1, 2023,'' before ``the State 
                        shall''.
            (2) Title xi.--Section 1144 of the Social Security Act (42 
        U.S.C. 1320b-14) is amended--
                    (A) in subsection (a)--
                            (i) in paragraph (1)(A)--
                                    (I) by striking ``sections 
                                1902(a)(10)(E) and 1933'' and inserting 
                                ``section 1902(a)(10)(E) and (prior to 
                                January 1, 2023) section 1933'';
                                    (II) by striking ``for the 
                                transitional assistance under section 
                                1860D-31(f), or'' and inserting a 
                                comma; and
                                    (III) by inserting ``, or for 
                                Medicare premium and cost-sharing 
                                assistance under section 1899B (in the 
                                case of months beginning on or after 
                                January 1, 2023)'' before the 
                                semicolon; and
                            (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'' and inserting ``section 
                        1902(a)(10)(E) and (prior to January 1, 2023) 
                        section 1933'';
                            (ii) by striking ``for transitional 
                        assistance 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,) provide an 
                        application for enrollment under the Medicare 
                        Savings Program'' before the period;
                            (ii) in paragraph (2), in the paragraph 
                        header, by inserting ``medicare savings program 
                        application and'' before ``lis application''; 
                        and
                            (iii) in paragraph (7), by striking ``means 
                        the program of medical assistance'' and all 
                        that follows through the period and inserting 
                        ``means--
                    ``(A) prior to January 1, 2023, the program of 
                medical assistance for payment of the cost of medicare 
                cost-sharing under the Medicaid program pursuant to 
                sections 1902(a)(10)(E) and 1933; and
                    ``(B) beginning January 1, 2023, the program for 
                medical assistance for payment of the cost of medicare 
                cost-sharing for qualified disabled and working 
                individuals described in section 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 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)) as of December 31, 2022, receive Medicare cost 
assistance under section 1899B of such Act, as added by section 2, as 
of January 1, 2023.

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 INDIVIDUALS 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 Percent'' 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 subparagraph 
                        (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 paragraph 
                                (3)(B)(i)'' and inserting ``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'' at the end;
                                    (II) in clause (ii)--
                                            (aa) by striking ``150 
                                        percent'' and inserting ``200 
                                        percent''; 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 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' 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.''.
                            (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)'' 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--
            (1) by striking ``who would be such an institutionalized 
        individual or couple, if the full-benefit dual eligible 
        individual were not''; and
            (2) by striking ``or subsection (c) or (d) of section 1915 
        or under a State plan amendment under subsection (i) of such 
        section'' and inserting ``, section 1115A, section 1915, or 
        under a State plan amendment''.
    (c) Effective Date.--The amendments made by this section shall 
apply to plan year 2023 and subsequent plan years.
                                 <all>