Advancing Enrollment and Reducing Drug Costs Act
The Advancing Enrollment and Reducing Drug Costs Act would amend the Medicare statute to automatically qualify certain low-income Medicaid beneficiaries for premium and cost-sharing subsidies under Medicare Part D. Specifically, it creates a new automatic eligibility pathway for individuals who are enrolled in Medicaid under a state plan (Title XIX) or a Medicaid waiver, are approaching or just turning 65, and have income at or below 200% of the federal poverty line. These individuals would be treated as Part D subsidy-eligible for a limited period, with the exact duration to be set by the Secretary of Health and Human Services. The changes would apply to plan years beginning on or after January 1, 2027. In short, the bill aims to reduce drug costs for a defined group of low-income, near-retirement-age Medicaid beneficiaries by automatically extending Medicare Part D subsidies they would otherwise have to qualify for separately, starting in 2027.
Key Points
- 1Automatic subsidy qualification: The bill adds a new automatic eligibility category for Part D premium and cost-sharing subsidies for certain Medicaid-enrolled individuals who are about to turn 65, so they don’t have to apply separately for these subsidies.
- 2Income threshold: Eligibility is limited to those with income at or below 200% of the federal poverty line (FPL) for their family size.
- 3Geographic/ program eligibility: Applies to people enrolled in medical assistance under a state plan under title XIX (or a waiver) at age 65, under specific Medicaid enrollment provisions.
- 4Limited duration: The automatic subsidy eligibility is for a limited period, with the length to be determined by the Secretary of Health and Human Services.
- 5Effective date: These changes apply to Medicare plan years beginning on or after January 1, 2027.