Healthcare (Medicare)

This bill removes marriage restrictions that previously caused Disabled Adult Children (DACs) to lose Social Security disability benefits upon marriage. It amends Social Security rules to treat married DACs the same as unmarried ones for eligibility, ensuring they retain benefits for child's insurance based on a disability. Key provisions prevent states from counting a spouse's income/resources against a married DAC and guarantee Medicaid eligibility remains unchanged if the DAC would qualify as unmarried. The bill directly affects DACs receiving Social Security Disability Insurance (SSDI) through a parent's account who are married, ensuring they maintain access to Medicare, Medicaid, and SSDI benefits without geographic or marital status barriers.

This bill adds Medicare coverage for home-based treatment of Alpha-1 Antitrypsin Deficiency Disorder (a rare genetic condition causing lung and liver damage). It specifically covers "augmentation therapy" (replacement protein therapy) delivered at home by qualified suppliers to Medicare Part A and B enrollees with this diagnosis who aren't in Medicare Advantage plans. The bill establishes payment for intravenous kits and up to 2 hours of nursing services per session, set at 80% of the lesser of actual cost or a defined rate. It amends Medicare rules to include this treatment under coverage, effective January 2027.

Lower Costs for Everyday Americans Act This bill reauthorizes and establishes programs and requirements regarding health, commerce, and the environment. The bill reauthorizes and expands programs for health care, including by allowing individuals age 65 and over with a medically improved disability to qualify for Medicaid; extending payment increases for certain providers under Medicare, including physicians and rural hospitals;  extending Medicare coverage of certain telehealth services; requiring pharmacy benefit managers to remit 100% of rebates for prescription drugs to group health plans;  reauthorizing programs supporting health care in underserved communities, including the National Health Service Corps; expanding and reauthorizing programs for public health emergency preparedness and response, including pandemic preparedness;  expanding and reauthorizing programs for prevention and treatment of certain conditions, including substance use disorders, traumatic brain injuries, and sickle cell disease; and expanding the Food and Drug Administration’s authority regarding research on rare pediatric diseases. The bill also establishes requirements relating to commerce, including by  prohibiting nonconsensual online publication of intimate visual depictions of individuals,  requiring manufacturers of internet-connected devices to disclose whether the device has a camera or microphone prior to purchase, banning products containing 10% or more of sodium nitrite by weight, and requiring additional disclosures relating to the prices of concert tickets and hotel rooms. Additionally, the bill establishes and reauthorizes programs relating to the environment, including grants for community recycling systems, drinking water infrastructure, and reducing diesel emissions. It also allows gasoline that is blended with 10% to 15% ethanol to be sold year-round.

Sustainable Cardiopulmonary Rehabilitation Services in the Home Act This bill permanently allows services relating to cardiac rehabilitation programs, intensive cardiac rehabilitation programs, and pulmonary rehabilitation programs to be furnished via telehealth at a beneficiary's home under Medicare.

Metastatic Breast Cancer Access to Care Act This bill expedites payment of Social Security Disability Insurance (SSDI) benefits and eligibility for Medicare coverage for those with metastatic breast cancer (i.e., breast cancer that has spread to other sites in the body). Specifically, the bill eliminates the 5-month waiting period for SSDI benefits and the subsequent 24-month waiting period for Medicare coverage for individuals with metastatic breast cancer. Under current law, individuals generally must wait 5 months after the onset of disability to begin receiving SSDI benefits and an additional 24 months to become eligible for Medicare.

This bill automatically qualifies certain Medicaid beneficiaries for Medicare Part D prescription drug subsidies when they turn 65. Specifically, it treats individuals enrolled in Medicaid under specific state plan provisions (as defined in Section 1902(a)(10)(A)) with income below 200% of the poverty line as "subsidy eligible" for Part D, without requiring additional application. The provision applies to those who were enrolled in Medicaid the day before turning 65, and the subsidy period is limited as determined by the Secretary. It takes effect for Medicare plan years beginning January 1, 2027. The bill does not change drug pricing but streamlines access to existing subsidy programs for this group.

HR 3665, the Medicare Economic Security Solutions Act, modifies Medicare Part B late enrollment penalties. It increases the penalty rate from 10% to 15% of the monthly premium but limits the penalty period to twice the original 12-month intervals. The bill also excludes months with COBRA, retiree, or VA coverage from counting toward the penalty and creates a special enrollment period for people whose COBRA or retiree coverage ends. These changes directly affect Medicare Part B enrollees who had gaps in coverage due to employment transitions or other qualifying circumstances.

HR 1921, the Hearing Device Coverage Clarification Act, requires Medicare to clarify that fully implanted active middle ear hearing devices are prosthetics - not excluded hearing aids - ensuring they qualify for coverage under Medicare's prosthetic benefit. This change directly affects Medicare beneficiaries, particularly seniors and individuals with hearing impairments who rely on these implanted devices. The bill mandates the Centers for Medicare & Medicaid Services (CMS) to issue this clarification within 60 days of enactment, using the existing federal definition of "prosthetic" from the Code of Federal Regulations. This policy adjustment removes an administrative barrier, allowing Medicare to cover these devices without requiring separate policy changes.

The HEARD Act of 2025 directs the National Institutes of Health (NIH) to expand and coordinate research on rare diseases with a specific focus on health equity for minority populations. It requires NIH to establish a Coordinating Committee involving multiple federal agencies to develop a comprehensive plan for addressing rare diseases in minority communities, including research on epidemiology, diagnosis, and treatment. The bill creates new grant programs for data collection on rare diseases in minority populations, physician training programs on rare diseases, and scholarship/loan repayment programs for health professionals serving these communities, while also mandating reports to Congress on federal efforts to address these health disparities.

Stop the Wait Act of 2025 This bill phases out the initial waiting period for Social Security Disability Insurance (SSDI) benefits and eliminates the waiting period for certain disabled individuals to become eligible for Medicare.  Under current law, individuals generally must wait five months after the onset of disability to begin receiving SSDI benefits. The bill would gradually reduce this waiting period before eliminating it entirely in the year 2030.  Further, the bill would eliminate the 24-month waiting period for certain disabled workers and other individuals to become eligible for Medicare. Under current law, individuals under the age of 65 may generally enroll in Medicare after they have been eligible for SSDI or Social Security child’s, widow’s, or widower’s benefits by reason of disability for 24 months. The bill would eliminate this waiting period for individuals for whom the annual cost of certain medical insurance would exceed a specified percentage of their household income (i.e., those who cannot afford minimum essential coverage). Medicare eligibility for these individuals must be available retroactively to the first month that an individual qualified for SSDI or Social Security child’s, widow’s, or widower’s benefits by reason of disability.