Title: Improving Medicare Coverage Act
Policy area: Health

Summary:
Improving Medicare Coverage Act
This bill temporarily expands eligibility for Medicare. It also temporarily establishes a premium and cost-sharing assistance program for low-income beneficiaries.
Specifically, the bill lowers the age of eligibility for Medicare from 65 to 60. The Centers for Medicare & Medicaid Services must establish procedures to provide for automatic enrollment of qualifying individuals. Enrollment must be completed within 11 months of the bill's enactment.
The bill also 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.
The bill's provisions generally take effect six months after the bill's enactment and terminate five years later.

[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5165 Introduced in House (IH)]

<DOC>






117th CONGRESS
  1st Session
                                H. R. 5165

 To amend titles II and XVIII of the Social Security Act to lower the 
        Medicare eligibility age to 60, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 3, 2021

Ms. Jayapal (for herself, Mr. Lamb, Mr. Neguse, Ms. Wild, Ms. Stevens, 
  Mrs. Dingell, Ms. Adams, Mr. Aguilar, Mrs. Axne, Ms. Barragan, Ms. 
    Bass, Mr. Blumenauer, Ms. Bonamici, Mr. Bowman, Mr. Brown, Ms. 
Brownley, Ms. Bush, Mr. Carbajal, Mr. Cardenas, Mr. Carson, Mr. Carter 
of Louisiana, Mr. Castro of Texas, Ms. Chu, Mr. Cicilline, Ms. Clark of 
  Massachusetts, Ms. Clarke of New York, Mr. Cohen, Mr. Connolly, Mr. 
 Correa, Mr. Courtney, Ms. Craig, Ms. Dean, Mr. DeFazio, Ms. DeGette, 
Ms. DeLauro, Mr. DeSaulnier, Mr. Michael F. Doyle of Pennsylvania, Mr. 
 Espaillat, Mr. Evans, Mr. Gallego, Mr. Garcia of Illinois, Ms. Garcia 
of Texas, Mr. Green of Texas, Mr. Grijalva, Mrs. Hayes, Mr. Higgins of 
  New York, Mr. Horsford, Mr. Huffman, Ms. Jackson Lee, Ms. Jacobs of 
California, Mr. Johnson of Georgia, Mr. Jones, Mr. Kahele, Ms. Kaptur, 
Mr. Khanna, Mr. Kim of New Jersey, Mr. Krishnamoorthi, Ms. Kuster, Mr. 
Larsen of Washington, Mr. Larson of Connecticut, Mrs. Lawrence, Ms. Lee 
 of California, Ms. Leger Fernandez, Mr. Levin of Michigan, Mr. Lieu, 
 Mr. Lowenthal, Mrs. Carolyn B. Maloney of New York, Ms. Manning, Ms. 
  Matsui, Ms. McCollum, Mr. McEachin, Mr. McGovern, Mr. McNerney, Ms. 
Meng, Mr. Mfume, Mr. Morelle, Mr. Moulton, Mr. Nadler, Mrs. Napolitano, 
Ms. Newman, Mr. Norcross, Ms. Norton, Ms. Ocasio-Cortez, Ms. Omar, Mr. 
   Payne, Mr. Perlmutter, Mr. Phillips, Ms. Pingree, Mr. Pocan, Ms. 
Porter, Ms. Pressley, Mr. Quigley, Mr. Raskin, Mr. Rush, Mr. Ryan, Ms. 
  Sanchez, Mr. Sarbanes, Ms. Scanlon, Ms. Schakowsky, Mr. Schiff, Mr. 
Sherman, Mr. Smith of Washington, Mr. Soto, Ms. Strickland, Mr. Suozzi, 
 Mr. Takano, Mr. Thompson of California, Mr. Thompson of Mississippi, 
Ms. Titus, Ms. Tlaib, Mr. Tonko, Mrs. Torres of California, Mr. Torres 
  of New York, Mrs. Trahan, Mr. Vargas, Ms. Velazquez, Ms. Wasserman 
 Schultz, Mrs. Watson Coleman, Ms. Williams of Georgia, Ms. Wilson of 
  Florida, Mr. Yarmuth, Ms. Lofgren, Mr. Meeks, Mr. Danny K. Davis of 
    Illinois, Ms. Johnson of Texas, Mrs. Kirkpatrick, Mr. Crow, Mr. 
Jeffries, Mr. Cleaver, and Ms. Escobar) introduced the following bill; 
  which was referred to the Committee on Energy and Commerce, and in 
    addition to the Committee on Ways and Means, for a period to be 
subsequently determined by the Speaker, in each case for consideration 
  of such provisions as fall within the jurisdiction of the committee 
                               concerned

_______________________________________________________________________

                                 A BILL


 
 To amend titles II and XVIII of the Social Security Act to lower the 
        Medicare eligibility age to 60, 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 ``Improving Medicare Coverage Act''.

SEC. 2. MEDICARE ELIGIBILITY EXPANSION.

    (a) In General.--Section 226 of the Social Security Act (42 U.S.C. 
426) is amended--
            (1) by striking ``65'' each place it appears and inserting 
        ``60''; and
            (2) in subsection (a)--
                    (A) in paragraph (2)(A)--
                            (i) by inserting ``would be entitled to 
                        those benefits but for age,'' after ``section 
                        202,''; and
                            (ii) by inserting ``(not including age)'' 
                        after ``meets all the criteria''; and
                    (B) in the matter at the end--
                            (i) by inserting ``, in the case of an 
                        individual who has attained age 65 before the 
                        date that is 6 months after the date of the 
                        enactment of the Improving Medicare Coverage 
                        Act,'' after ``beginning with''; and
                            (ii) by inserting ``and, in the case of an 
                        individual who has not attained age 65 before 
                        the date that is 6 months after the date of the 
                        enactment of the Improving Medicare Coverage 
                        Act, the first month after the month that is 5 
                        months after such date of enactment for which 
                        the individual meets the conditions specified 
                        in paragraphs (1) and (2)'' after ``and (2)''.
    (b) Enrollment Periods for Part B Benefits.--Section 1837(d) of the 
Social Security Act (42 U.S.C. 1395p(d)) is amended--
            (1) by striking ``(d) In the case of'' and inserting 
        ``(d)(1) Subject to paragraph (2), in the case of''; and
            (2) by adding at the end the following new paragraph:
    ``(2) In the case of an individual described in paragraph (1) who 
has attained the age of 60 but not attained the age of 65 before the 
date that is 6 months after the date of the enactment of the Improving 
Medicare Coverage Act, such individual's initial enrollment period 
shall begin on the date that is 3 months after such date of enactment, 
and shall end on the date that is 11 months after such date of 
enactment.''.
    (c) Conforming Amendments.--
            (1) Hospital insurance benefits for the aged.--Section 1811 
        of the Social Security Act (42 U.S.C. 1395c) is amended--
                    (A) by striking ``65'' each place it appears and 
                inserting ``60''; and
                    (B) by striking ``(or would be eligible for such 
                benefits if certain government employment were covered 
                employment under such title)'' and inserting ``(or 
                would be eligible for such benefits if certain 
                government employment were covered employment under 
                such title, or would be eligible for such benefits but 
                for age)''.
            (2) Hospital insurance benefits for uninsured elderly 
        individuals not otherwise eligible.--Section 1818 of such Act 
        (42 U.S.C. 1395i-2) is amended--
                    (A) in subsection (a)(1), by striking ``65'' and 
                inserting ``60''; and
                    (B) in subsection (d)--
                            (i) in paragraph (1), by striking ``65'' 
                        and inserting ``60''; and
                            (ii) in paragraph (3), by striking ``65'' 
                        and inserting ``60''.
            (3) Hospital insurance benefits for disabled individuals 
        who have exhausted other entitlement.--Section 1818A(a)(1) of 
        such Act (42 U.S.C. 1395i-2a(a)(1)) is amended by striking 
        ``65'' and inserting ``60''.
            (4) Eligible individuals.--Section 1836(2) of such Act (42 
        U.S.C. 1395o(2)) is amended by striking ``65'' and inserting 
        ``60''.
            (5) Enrollment periods.--Section 1837 of such Act (42 
        U.S.C. 1395p), as amended by subsection (b), is further amended 
        by striking ``65'' each place it appears and inserting ``60''.
            (6) Coverage period.--Section 1838 of the such Act (42 
        U.S.C. 1395q) is amended--
                    (A) by striking ``65'' each place it appears and 
                inserting ``60''; and
                    (B) in subsection (a)(2)--
                            (i) by striking ``subsection (d)'' each 
                        place it appears and inserting ``subsection 
                        (d)(1)'';
                            (ii) in subparagraph (D), by striking ``; 
                        or'' and inserting ``, or''; and
                            (iii) by adding at the end the following 
                        new subparagraph:
            ``(E) in the case of an individual who enrolls pursuant to 
        subsection (d)(2) of section 1837, on the date that is 6 months 
        after the date of the enactment of the Improving Medicare 
        Coverage Act; or''.
            (7) Amounts of premiums.--Section 1839 of such Act (42 
        U.S.C. 1395r) is amended--
                    (A) in subsection (a)(1)--
                            (i) by striking the first sentence and 
                        inserting ``The Secretary shall, during 
                        September of 1983 through September of 2021, 
                        determine the monthly actuarial rate for 
                        enrollees age 65 and over which shall be 
                        applicable for the succeeding calendar year 
                        (including, for 2022, with respect to 
                        individuals who enroll pursuant to subsection 
                        (d)(2) of section 1837) and, during September 
                        of 2022 and of each year thereafter, determine 
                        the monthly actuarial value for enrollees age 
                        60 and over which shall be applicable for the 
                        succeeding calendar year.''; and
                            (ii) by inserting ``(for years before 2023 
                        and with respect to those enrollees age 50 or 
                        older (for 2023 and subsequent years)'' after 
                        ``age 60 and older'';
                    (B) in subsection (a)(3)--
                            (i) by striking ``for enrollees age 65 and 
                        over, determined according to paragraph (1),'' 
                        and inserting ``determined according to 
                        paragraph (1)''; and
                            (ii) by striking ``age 65 and older'';
                    (C) in subsection (a)(4)--
                            (i) by striking the first sentence and 
                        inserting ``The Secretary shall, during 
                        September of 1983 through September of 2021, 
                        determine the monthly actuarial rate for 
                        disabled enrollees under age 65 which shall be 
                        applicable for the succeeding calendar year 
                        and, during September of 2022 and of each year 
                        thereafter, determine the monthly actuarial 
                        value for disabled enrollees under age 60 which 
                        shall be applicable for the succeeding calendar 
                        year.''; and
                            (ii) by inserting ``(for years before 2023) 
                        and with respect to those disabled enrollees 
                        under age 60 (for 2023 and subsequent years)'' 
                        after ``to disabled enrollees under age 65'';
                    (D) in subsection (b), 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 Coverage Act) or the age of 
                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 ``the age of 65'';
                    (E) in subsection (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 the Improving Medicare Coverage Act) or the age of 
                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 ``age 65'';
                    (F) in subsection (i)(3)(A), by inserting ``(for 
                years before 2023) or for enrollees age 60 and older 
                (for 2023 and subsequent years)'' after ``age 65 and 
                older''; and
                    (G) in subsection (j), by inserting ``(for years 
                before 2023) or for enrollees age 60 and older (for 
                2023 and subsequent years)'' after ``age 65 and 
                older''.
            (8) Appropriations to cover government contributions and 
        contingency reserve.--Section 1844(a) of such Act (42 U.S.C. 
        1395w(a)) is amended by striking ``65'' each place it appears 
        and inserting ``60''.
            (9) Eligibility, election, and enrollment.--Section 
        1851(e)(4) of such Act (42 U.S.C. 1395w-21(e)(4)) is amended in 
        the matter at the end by striking ``65'' and inserting ``60''.
            (10) Premiums; late enrollment penalty.--Section 1860D-
        13(b)(7)(B)(i) of such Act (42 U.S.C. 1395w-113(b)(7)(B)(i)) 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 Coverage 
        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''.
            (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 medicare 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 supplemental 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 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 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
                            (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 Coverage 
        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 
                        semicolon 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.--Coverage 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 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 Entitled to Part A.--The 
Secretary of Health and Human Services shall establish procedures to 
provide for the automatic enrollment of individuals who become entitled 
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 individuals 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 Dependents.--Nothing in 
this section shall be construed to--
            (1) provide coverage under the Medicare program 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.
    (g) Clarification of Medicare as Secondary Payer.--Nothing in this 
section shall affect the requirements 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 effect 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 effect 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 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 the day 
                prior to the date that is 6 months after the date of 
                the enactment of the Improving Medicare Coverage Act; 
                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 on 
the date that is 6 months after the date of the enactment of the 
Improving Medicare Coverage Act, 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 on the date that is 6 months after the date 
        of the enactment of the Improving Medicare Coverage Act, 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 enactment of the Improving 
        Medicare Coverage Act, 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 the date 
that is 6 months after the date of the enactment of the Improving 
Medicare Coverage Act.''.
                    (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 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 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 2022 through 
        2024, 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. 4. 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 
        the date that is 6 months after the date of the enactment of 
        the Improving Medicare Coverage Act,'' 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 the date that is 6 months 
                after the date of the enactment of the Improving 
                Medicare Coverage Act'' 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 the date 
                that is 6 months after the date of the enactment of the 
                Improving Medicare 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 described in section 1905(s)) furnished 
        during calendar 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 sentence, 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 ``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 (prior to the date that is 6 
                        months after the date of the enactment of the 
                        Improving Medicare Coverage Act''; 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 the date that is 6 months 
        after the date of the enactment 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 enactment.''.
                    (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 the 
                        date that is 6 months after the date of the 
                        enactment of the Improving Medicare Coverage 
                        Act, make determinations''; and
                            (ii) in paragraph (3), by inserting ``prior 
                        to the date that is 6 months after the date of 
                        the enactment of the Improving Medicare 
                        Coverage Act,'' 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 
                                the date that is 6 months after the 
                                date of the enactment of the Improving 
                                Medicare Coverage Act) 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 
                                the date that is 6 months after the 
                                date of the enactment of the Improving 
                                Medicare Coverage Act)'' 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 the date that is 6 
                        months after the date of the enactment of the 
                        Improving Medicare Coverage Act) 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 on the date that is 6 months 
                        after the date of the enactment of the 
                        Improving Medicare Coverage Act) 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 the date that is 6 months after the 
                date of the enactment of the Improving Medicare 
                Coverage Act, 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 on the date that is 6 months after 
                the date of the enactment of the Improving Medicare 
                Coverage Act, 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 3 months 
after the date of the enactment of this Act, 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 the day prior 
to the date that is 6 months after the date of the enactment of this 
Act, receive Medicare cost assistance under section 1899B of such Act, 
as added by section 3, as of the date that is 6 months after such date 
of enactment.

SEC. 5. 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.''; and
                            (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 years beginning on or after the date that is 6 months 
after the date of the enactment of this Act, and apply on or after such 
date.

SEC. 6. SUNSET.

    Effective on the date that is 5 years after the date that is 6 
months after the date of the enactment of the Improving Medicare 
Coverage Act, this Act (including the amendments made by this Act) is 
repealed, and any provision of law amended or repealed by this Act is 
hereby restored or revived as if this Act had not been enacted into 
law.
                                 <all>