Title: Helping Seniors Afford Medicare Act of 2018
Policy area: Health

Summary:
Helping Seniors Afford Medicare Act of 2018
This bill makes a series of changes relating to Medicare enrollment, eligibility, and cost-sharing, such as by establishing an annual out-of-pocket limit for enrollees and reducing cost-sharing for certain low-income individuals.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 3316 Introduced in Senate (IS)]

<DOC>






115th CONGRESS
  2d Session
                                S. 3316

    To amend title XVIII of the Social Security Act to improve the 
 affordability and enrollment procedures of the Medicare program, and 
                          for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             August 1, 2018

  Mr. Nelson introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
    To amend title XVIII 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 Representatives 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 ``Helping Seniors 
Afford Medicare Act of 2018''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

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. Improving Medicare beneficiary enrollment procedures and 
                            effective dates of coverage.

SEC. 2. PROTECTING AGAINST HIGH OUT-OF-POCKET EXPENDITURES FOR MEDICARE 
              FEE-FOR-SERVICE BENEFITS.

    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:

          ``protection against high out-of-pocket expenditures

    ``Sec. 1899C.  (a) In General.--Notwithstanding any other provision 
of this title, in the case of an individual 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 2019) 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) constitute incurred expenses for 
        which benefits are payable under part B, shall be 100 percent 
        of such amount for the remainder of that year; and
            ``(2) the individual shall not be responsible for out-of-
        pocket cost-sharing incurred during the remainder of that year.
    ``(b) Annual Out-of-Pocket Limit.--
            ``(1) In general.--The amount of the annual out-of-pocket 
        limit under this subsection shall be--
                    ``(A) for 2019, $5,500; or
                    ``(B) for a subsequent year, the amount specified 
                in this subsection for the preceding year increased or 
                decreased by the percentage change in the Consumer 
                Price Index for All Urban Consumers for the 12-month 
                period ending with June of such preceding year.
            ``(2) Rounding.--If any amount determined under paragraph 
        (1)(B) is not a multiple of $5, such amount shall be rounded to 
        the nearest multiple of $5.
    ``(c) Out-of-Pocket Cost-Sharing Defined.--
            ``(1) In general.--Subject to paragraphs (2) and (3), in 
        this section, the term `out-of-pocket cost-sharing' means, with 
        respect to an individual, the amount of the expenses incurred 
        by the individual that are attributable to--
                    ``(A) deductibles, coinsurance and copayments 
                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 services.--Expenses 
                incurred for items and services 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 furnished on an 
                assignment-related basis.--If an item or service is 
                furnished to an individual under this title and is not 
                furnished on an assignment-related basis, any 
                additional expenses the individual incurs above the 
                amount the individual would have incurred if the item 
                or service was furnished on an assignment-related basis 
                shall not be considered incurred expenses for purposes 
                of determining out-of-pocket cost-sharing under 
                paragraph (1).
            ``(3) Source of payment.--For purposes of paragraph (1), 
        the Secretary shall consider expenses to be incurred by the 
        individual without regard to whether the individual or another 
        person, including a State program, an employer, a medicare 
        supplemental 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 2019) 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 SIMPLIFYING ENROLLMENT FOR LOW-INCOME 
              BENEFICIARIES.

    (a) Increase in Income Eligibility to 135 Percent of FPL for 
Qualified Medicare Beneficiaries.--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 percent'' and 
        inserting ``135 percent'';
            (2) in subparagraph (B)--
                    (A) by striking ``and'' at the end of clause (ii);
                    (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, 2020, 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, 2020, is 135 percent.''.
    (b) Increase in Income Eligibility to 150 Percent of FPL for 
Specified Low-Income Medicare Beneficiaries.--
            (1) Eligibility of individuals with incomes 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 before 
                        2020, and 150 percent in 2020 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 inserting after 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 Social Security Act (42 
U.S.C. 1396d) is amended--
            (1) in subsection (b), by striking ``and (aa)'' and 
        inserting ``(aa), and (ee)''; and
            (2) 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 paragraph (2), the Federal 
        medical assistance percentage shall be equal to 100 percent.
            ``(2) Expenditures described.--The expenditures described 
        in this paragraph are expenditures made on or after January 1, 
        2020, for medical assistance 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, 2018.''.
    (d) Consolidation of Low-Income Subsidy Resource 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 relating to income and 
        resource determinations.--Section 1860D-14(a)(3) of the Social 
        Security Act (42 U.S.C. 1395w-114(a)(3)), as amended by 
        paragraph (1), is amended by striking subparagraph (F) and 
        inserting the new following new subparagraphs:
                    ``(F) Resource exclusions.--In determining 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 
                        insurance policy shall be taken into account;
                            ``(ii) no part of the value of any vehicle 
                        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 resources of such 
                        individual or spouse will be used to meet the 
                        burial and related expenses 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 individual under this 
                section, an individual's family shall consist of--
                            ``(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 
                                individual 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 preceding 
                subparagraph (A), by inserting ``(as determined under 
                paragraph (3)(G))'' after ``family of the size 
                involved''; and
                    (B) in paragraph (3), as amended by paragraphs (1) 
                and (2)--
                            (i) in subparagraph (A), in the matter 
                        preceding clause (i), by striking 
                        ``subparagraph (F)'' and inserting 
                        ``subparagraph (E)'';
                            (ii) in subparagraph (A)(ii), by inserting 
                        ``(as determined under subparagraph (G))'' 
                        after ``family of the size involved'';
                            (iii) in subparagraph (A)(iii), by striking 
                        ``or (E)'';
                            (iv) in subparagraph (B)(v), in the matter 
                        preceding subclause (I), by striking 
                        ``subparagraph (F)'' and inserting 
                        ``subparagraph (E)''; and
                            (v) in subparagraph (D)(i), in the matter 
                        preceding subclause (I), by striking ``subject 
                        to the life insurance policy exclusion provided 
                        under subparagraph (G)'' and inserting 
                        ``subject to the resource exclusions provided 
                        under subparagraph (F)''.
    (e) Alignment of Low-Income Subsidy and Medicare Savings Program 
Income and Resource Eligibility Tests.--
            (1) Application of medicaid spousal impoverishment 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 section 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 follows:
            ``(3) whose resources (as determined under section 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 
                        requirement of this subparagraph is that an 
                        individual's resources (as determined under 
                        section 1613 for purposes of the supplemental 
                        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).''.
    (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 before 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 
                qualified medicare beneficiary described in subsection 
                (p)(1), if provided after the month in which the 
                individual becomes such a beneficiary''.
            (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;
                    (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 benefits under a State 
plan approved under this title under any of the following eligibility 
categories, or who is redetermined to be eligible for such benefits 
under any of such categories, shall be considered to meet the 
eligibility requirements met on the date of application and shall 
remain 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 provide for such determinations 
more frequently, but not more frequently than once every 6 months for 
an individual:
            ``(i) A specified low-income medicare beneficiary described 
        in subsection (a)(10)(E)(iii) of this section who is determined 
        eligible for medicare cost sharing described in section 
        1905(p)(3)(A)(ii).
            ``(ii) A qualified disabled and working individual 
        described in section 1905(s) who is determined eligible for 
        medicare cost-sharing described in section 1905(p)(3)(A)(i).''.
            (3) State option to use express lane eligibility 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 express lane 
                        eligibility to other populations.--
                                    ``(I) In general.--At the option of 
                                the State, the State may apply the 
                                provisions of this paragraph with 
                                respect 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 respect to this title 
                                (other than a reference to child health 
                                assistance) shall be deemed to be a 
                                reference to an eligible individual.
                                    ``(II) Eligible individual 
                                defined.--In this clause, the term 
                                `eligible individual' means any of the 
                                following:
                                            ``(aa) A qualified medicare 
                                        beneficiary described in 
                                        section 1905(p)(1) for purposes 
                                        of determining eligibility for 
                                        medicare cost-sharing (as 
                                        defined in section 1905(p)(3)).
                                            ``(bb) A specified low-
                                        income medicare beneficiary 
                                        described in subsection 
                                        (a)(10)(E)(iii) of this section 
                                        for purposes of determining 
                                        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 medicare cost-
                                        sharing described in section 
                                        1905(p)(3)(A)(i).
                                            ``(dd) During the period 
                                        that begins on the date of 
                                        enactment of this clause and 
                                        ends on December 31, 2019, a 
                                        qualifying individual described 
                                        in subsection (a)(10)(E)(iv) 
                                        for purposes of determining 
                                        eligibility for medicare cost-
                                        sharing described in section 
                                        1905(p)(3)(A)(ii).''.
    (g) Effective Date.--
            (1) In general.--Except as provided in paragraphs (2) and 
        (3), the amendments and repeal made by this section take effect 
        on January 1, 2020, and, with respect to title XIX of the 
        Social Security Act, apply to calendar quarters beginning on or 
        after January 1, 2020.
            (2) Express lane eligibility for msp.--The amendments made 
        by subsection (f)(3) take effect 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 Secretary of Health and Human Services 
        determines requires State legislation (other than legislation 
        appropriating funds) in order for the plan to meet the 
        additional 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 
        before the first day of the first calendar quarter beginning 
        after the close of the first regular session of the State 
        legislature that begins after the date of the enactment 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-INCOME 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, 2019, to an applicable low-income individual, the amount of 
any coinsurance 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 Defined.--
            ``(1) In general.--In this section, the term `applicable 
        low-income individual' means an individual--
                    ``(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 applicable 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 determination of 
        eligibility for medical assistance under title XIX.
    ``(c) Establishment of Procedures for Identification of Applicable 
Low-Income Individuals and Notification of Providers of Services and 
Suppliers.--
            ``(1) In general.--The Secretary, in consultation with the 
        Commissioner of Social Security and the Secretary of the 
        Treasury, shall establish procedures for--
                    ``(A) the determination of whether an individual is 
                an applicable low-income individual; and
                    ``(B) the notification of providers of services and 
                suppliers in the case where an individual is an 
                applicable low-income individual so that the reduction 
                in any coinsurance or copayment 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 section 1860D-
                14(a)(3)(B)(i) shall apply to the determination of 
                whether an individual is an applicable low-income 
                individual under this section 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.--Determinations under this 
                subsection shall be effective for a period determined 
                appropriate by the Secretary.
    ``(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 coinsurance 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 provided under 
        section 1899D'' before the period at the end.

SEC. 5. IMPROVING MEDICARE BENEFICIARY ENROLLMENT 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 Periods.--
            ``(1) General enrollment.--
                    ``(A) For coverage during years before 2020.--There 
                shall be a general enrollment period during the period 
                beginning on January 1 and ending on March 31 of each 
                year before 2020.
                    ``(B) For coverage during years beginning with 
                2020.--Subject to subparagraph (B), there shall be a 
                general enrollment period beginning on October 15 and 
                ending on December 31 of 2019 and each subsequent year.
            ``(2) Special enrollment.--Beginning January 1, 2020, the 
        Secretary shall establish special enrollment periods in the 
        case of individual who meets such exceptional conditions as the 
        Secretary may provide.''.
    (b) Effective Dates of Coverage.--
            (1) In general.--Section 1838(a) of the Social Security Act 
        (42 U.S.C. 1395q(a)) is amended--
                    (A) by amending paragraph (2) to read as follows:
            ``(2)(A) in the case of an individual who enrolls pursuant 
        to subsection (d) of section 1837 before the month in which he 
        first satisfies paragraph (1) or (2) of section 1836, the first 
        day of such month; or
            ``(B) in the case of an individual not described in 
        subparagraph (A) who first satisfies such paragraph in a month 
        beginning before January 1, 2020 and who enrolls--
                    ``(i) pursuant to such subsection (d) in such month 
                in which he first satisfies such paragraph, the first 
                day of the month following the month in which he so 
                enrolls; or
                    ``(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 subsection (e) of 
        section 1837 in a month beginning--
                    ``(i) before April 1, 2019, the July 1 following 
                the month in which he so enrolls; or
                    ``(ii) on or after October 1, 2019, 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 paragraph in a month 
        beginning on or after January 1, 2020, 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 enrollment period, the first day of the month following 
        the month in which he so enrolls; or''; and
                    (B) in paragraph (3), by striking ``subparagraphs 
                (B), (C), (D), and (E) of paragraph (2) of this 
                subsection'' and inserting ``subparagraphs (B) and (C) 
                of paragraph (2), as applicable''.
            (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 Enrollment Penalty Time 
Limitation Provision to the Part B Late Enrollment Penalty.--
            (1) In general.--Section 1839(b) of the Social 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 described in the 
        first sentence.''.
            (2) Conforming amendment to the part a late enrollment 
        penalty.--Section 1818(c)(6) of the Social Security Act (42 
        U.S.C. 1395i-2(c)(6)) is amended by striking ``and shall only 
        apply to premiums paid during a period equal to twice the 
        number 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, 2020.
                    (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 determining 
                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 Enrollment Period and Limit on Late Enrollment 
Penalties.--
            (1) Application of part b deemed enrollment 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 ``, 
        exclusive 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 
        Secretary of Health and Human Services under section 
        1839(j)(1)(C) of such Act, as added by subsection (c)(2).
            (3) Transition providing special enrollment period and 
        limit on late enrollment penalties for certain medicare 
        beneficiaries.--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
                    (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 transition 
                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 
                individual may be enrolled under this part.
                    ``(B) Coverage period.--In the case of such an 
                individual who enrolls during such special 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 2019 and not later than January 2020, 
                specified by the Secretary.
            ``(2) Reduction in late enrollment penalties for current 
        enrollees and individuals enrolling during transition.--
                    ``(A) In general.--In the case of a transition 
                individual who is enrolled under this part as of the 
                day before the first day of the effective month or who 
                enrolls under this part on or after the date of the 
                enactment of this subsection but before the end of the 
                special enrollment 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 penalty otherwise 
                established.
                    ``(B) Application.--Subparagraph (A) shall be 
                applied in the case of a transition individual 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 and 
                        before the end of the special enrollment 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 period 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 individual was a 
        resident of Puerto Rico, regardless of whether the individual 
        is enrolled under this part as of such first day.''.
                                 <all>