The "Advancing Enrollment and Reducing Drug Costs Act" automatically enrolls eligible low-income Medicaid beneficiaries into Medicare Part D premium and cost-sharing subsidies upon turning 65, starting in 2027.
Chris Pappas
Representative
NH-1
The "Advancing Enrollment and Reducing Drug Costs Act" automatically qualifies specific low-income Medicaid beneficiaries for Medicare Part D premium and cost-sharing subsidies once they turn 65, ensuring continuous access to affordable medication. This change applies to individuals enrolled in Medicaid under sections 1902(a)(10)(A)(i)(VIII) or 1902(a)(10)(A)(ii)(XX) of Title XIX with incomes below 200% of the poverty line. These provisions will take effect for plan years beginning on or after January 1, 2027.
Bill Automates Medicare Drug Cost Help for Low-Income Medicaid Users Turning 65, Starts 2027
This bill, the "Advancing Enrollment and Reducing Drug Costs Act," basically sets up an automatic connection for certain folks moving from Medicaid to Medicare. If you're enrolled in specific Medicaid categories (like those under sections 1902(a)(10)(A)(i)(VIII) or 1902(a)(10)(A)(ii)(XX) of the Social Security Act) and your income is below 200% of the federal poverty line the day before you turn 65, this bill aims to automatically qualify you for help paying Medicare Part D (prescription drug plan) premiums and co-pays. Think of it as getting pre-approved for assistance based on your existing Medicaid status. This change is slated to kick in for Medicare plan years starting on or after January 1, 2027.
Making the Switch Simpler: Automatic Drug Cost Aid
Turning 65 and navigating the shift to Medicare can be a headache, especially when you're already managing on a tight budget. Currently, even if you qualify for help with Medicare drug costs (known as Part D subsidies or 'Extra Help'), you often have to apply separately. This bill targets that specific administrative hurdle. By amending the Social Security Act (Section 2), it essentially tells the system: "Hey, this person was just verified as low-income under these specific Medicaid rules, let's automatically treat them as eligible for Part D subsidies when they enroll in Medicare." The idea is to prevent a gap where someone might miss out on affordable medications simply because they didn't know about or couldn't navigate another application process during the transition. It's worth noting the bill gives the Secretary the power to decide how long this automatic qualification lasts, suggesting it might be an initial period rather than indefinite.
Who Gets the Assist?
This isn't for everyone on Medicaid turning 65. It's specifically for individuals enrolled under those two designated low-income categories and confirmed to be below 200% of the poverty line right before their Medicare eligibility begins. The practical effect is aimed at ensuring some of the most financially vulnerable seniors get connected to existing prescription drug assistance programs without extra paperwork. It leverages the information the government already has from Medicaid enrollment to streamline access to Medicare benefits, potentially making that transition smoother and ensuring better access to necessary medications from day one of their Medicare coverage, starting in 2027.