H.R. 10874: Medicare Low Income Subsidy Equality Act of 2026

This bill would change how certain Medicare prescription drug subsidies are calculated for low-income beneficiaries who live in Puerto Rico and other U.S. territories.

What it would do

• It would make premium and cost-sharing help under Medicare Part D available on the same general basis to low-income beneficiaries living in Puerto Rico and other U.S. territories as to beneficiaries in the 50 states and the District of Columbia.
• It would change the rules so that people in Puerto Rico and the territories are treated more like mainland residents when the government determines eligibility for these subsidies.
• It would use the poverty line for the 48 contiguous states and the District of Columbia when calculating subsidy eligibility for individuals who do not live in the 50 states or D.C.

Changes to Medicaid-related payments

• The bill also revises a separate payment formula tied to Medicaid-related assistance for Medicare prescription drug coverage.
• It would extend certain payment calculations to Puerto Rico and other territories beginning in January 2027.
• For those territories, it would create a new method for computing the amounts, generally based on prior-year amounts and updated each year by a growth factor.
• It would phase in higher funding adjustments starting in fiscal year 2027, with additional increases continuing in later years.
• The bill includes special rules for the last three quarters of fiscal year 2027, the first quarter of fiscal year 2027, and later fiscal years so the payment amounts are adjusted over time.

Timing

• The Medicare subsidy changes in subsection (a) would take effect on January 1, 2027.
• The Medicaid-related and conforming changes would take effect when the bill is enacted.

Relevant Companies

None found