Healthcare (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 1476, the PLASMA Act, adjusts discount rates for plasma-derived drugs under Medicare Part D starting in 2026. It sets gradually decreasing discount percentages (from 99% down to 90% by 2030) for these specific drugs when beneficiaries reach their annual out-of-pocket spending threshold. The bill directly affects Medicare Part D beneficiaries using plasma-derived biological products (drugs made from human blood or plasma) and the manufacturers of those drugs. Certain drugs for low-income subsidy beneficiaries and small manufacturers are excluded from these discount provisions. The law phases in these changes over several years to align with existing Medicare Part D cost-sharing rules.

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.

Radiation Oncology Case Rate Value Based Program Act of 2025 or the ROCR Value Based Program Act This bill establishes a specialized payment program under Medicare for providers and suppliers of radiation oncology services.  Specifically, the Centers for Medicare & Medicaid Services (CMS) must establish a program under which radiation therapy providers (i.e., hospital outpatient departments) and suppliers (i.e., physician group practices and freestanding radiation therapy centers) receive payments for each episode of care provided to individuals with specified types of cancer. An episode of care  means the period beginning on the day radiation therapy planning is furnished to the individual and ending (1) for individuals with bone or brain metastases, 30 days later; and (2) for individuals with other cancer types, 90 days later. Participation in the program is mandatory for providers and suppliers that participate in Medicare, unless the provider or supplier is part of a state-based Center for Medicare & Medicaid Innovation model or qualifies for a significant hardship exemption. The CMS must set payment rates for the program based on national payment rates with specified adjustments (e.g., geographic adjustments). Providers and suppliers who provide certain transportation services for individuals under their care may receive an additional payment. Providers and suppliers must be accredited in accordance with certain standards, subject to payment reductions. The Government Accountability Office must report on (1) implementation of the program, and (2) underserved areas that are in need of more or newer radiation therapy resources.

This bill requires five major federal agencies (Social Security Administration, Medicare, IRS, VA, and HUD) to certify to Congress before implementing significant changes like staff cuts exceeding 5% in a year or closing over 5% of regional offices. Agencies must prove such changes won’t reduce benefits, delay payments, increase wait times, or weaken outreach for eligible individuals. An Inspector General must study the impact within one year and, if problems are found, require the agency to reverse the changes (e.g., reinstating staff or reopening offices). The law aims to safeguard access to retirement, health, tax, and housing benefits for millions of Americans.

The Old Drugs, New Cures Act creates a new "priority research drug" designation for older medications being studied for new medical uses. It directly affects drug manufacturers who want to investigate existing drugs (approved over 10 years ago) for new indications addressing significant unmet medical needs, particularly for diseases affecting 33%+ of beneficiaries in federal health programs like Medicare, Medicaid, or VA care. Key provisions require the Secretary to designate such drugs within 60 days of a request, then exclude them from Medicaid and Medicare pricing rules that typically treat minor drug modifications as "line extensions." This exclusion allows manufacturers to potentially secure better reimbursement for these repurposed drugs under current program rules. The bill changes how these specific drugs are classified in federal healthcare programs, not the drugs' medical use.