Social Security and Medicare

This bill implements a means test for certain elementary and secondary school students aged 18 or older to collect Social Security child’s benefits.

Specifically, a child beneficiary aged 18 years or older may not be eligible for Social Security child’s benefits based on their status as a full-time elementary or secondary school student if the individual on whose wages and income the benefit is based (e.g., the child’s parent or guardian) (1) is entitled to Social Security benefits, (2) is 67 years of age or older, and (3) has more than $125,000 of annual earnings for the taxable year.

Rural ER Access Act

This bill requires the Centers for Medicare & Medicaid Services to repeal regulations that require off-campus facilities to be located within 35 miles of the main hospital or critical access hospital in order to receive provider-based status under Medicare (i.e., to be considered as hospital outpatient departments for purposes of Medicare payment).

Medicare Expansion and Lowering Costs Now Act

This bill establishes a Medicare buy-in option for certain qualifying individuals and makes a series of other changes relating to health care costs. It also repeals the health provisions that were enacted under what is commonly known as the One Big Beautiful Bill Act.

Specifically, the bill allows individuals aged 50 to 64 to enroll in Medicare if such individuals would otherwise qualify for Medicare at the age of 65. The Centers for Medicare & Medicaid Services (CMS) must determine enrollment periods and set premiums for the buy-in option established under the bill, in accordance with specified requirements. The CMS must also award grants to states and nonprofit organizations for outreach and enrollment activities relating to the buy-in option.

Additionally, the bill repeals the health provisions that were enacted under what is commonly known as the One Big Beautiful Bill Act. Among other provisions, the act required individuals who are eligible for Medicaid as part of the Medicaid expansion population to engage in community service, work, or other activities in order to qualify for Medicaid. (For more information about these and other health provisions in the act, see CRS Report R48633.)

The bill also (1) establishes a supplemental option under Medicare to cover cost-sharing for beneficiaries; (2) establishes an individual market reinsurance program relating to coverage of high-cost individuals, as specified; and (3) expands eligibility for the premium tax credit.

Protecting Social Security Act

This bill provides funds for Social Security benefits payments in the event of the insolvency of one or both of the Social Security trust funds, and provides for the expedited consideration of legislation to address such insolvency in Congress.

Specifically, for any period in which the balance of the Federal Old-Age and Survivors Insurance Trust Fund or the Federal Disability Insurance Trust Fund is insufficient to cover monthly payments to beneficiaries, the bill provides funding in the amount necessary to make such payments.

Further, the bill requires the Social Security Administration (SSA) to notify Congress of the insolvency of either trust fund, and makes certain legislation to address the insolvency eligible for expedited consideration upon such a notification. The bill sets forth certain requirements for eligible legislation, including that it must ensure that individuals entitled to Social Security or disability benefits continue to receive payments in full. The bill also sets out procedures for the consideration of eligible legislation in each chamber of Congress, including through specified time limits for committee consideration and a prohibition on amendments.

Finally, the bill requires SSA to maintain a field office in every U.S. county with a population of more than 150,000.

Protect Our Seniors Act

This bill establishes Senate budget enforcement procedures (known as points of order) against measures that (1) reduce Medicare or Social Security benefits, or (2) use revenue or savings from the Medicare program to offset the cost of provisions unrelated to carrying out Medicare.

Points of order are prohibitions against certain categories of legislation or congressional action. A point of order raised on the grounds established under the bill may be waived or suspended only by an affirmative vote of two-thirds of the Senators.

Apples to Apples Comparison Act of 2026

This bill requires additional reporting and disclosures regarding Medicare enrollment and expenditures.

Specifically, the bill requires the Centers for Medicare & Medicaid Services to annually report on and publish information on its website regarding expenditures for Medicare hospital services and medical services, the Medicare prescription drug benefit, and Medicare Advantage (MA), including for those who are enrolled in one program but not others or have supplemental insurance. This information must be broken down by county and metropolitan statistical area for each month over the prior 10-year period and for each month over the next 5-year period.

In addition, the Medicare Payment Advisory Commission must annually analyze and report on expenditures for Medicare beneficiaries who have an MA plan compared to those who do not have an MA plan. The Boards of Trustees for Medicare must annually report on expenditures for (1) Medicare beneficiaries who have either hospital services or medical services but not both, and (2) Medicare beneficiaries who have both hospital and medical services but do not have an MA plan.

This bill includes medically necessary cranial prostheses (e.g., wigs) as covered durable medical equipment under the Medicare program.

Survival Aid For Emergencies through Medicare Act or the SAFE through Medicare Act

This bill provides for Medicare coverage of medically necessary services for beneficiaries who are determined to be medically at-risk during a climate or manmade disaster (i.e., home resiliency services), such as heat pumps, batteries for medical equipment, and energy efficient storage for medical supplies.

Defense of Conscience in Health Care Act

This bill requires the Department of Health and Human Services (HHS) to issue a final rule on protecting statutory conscience rights in health care that is identical or equivalent to the rule titled Protecting Statutory Conscience Rights in Health Care; Delegations of Authority, which was scheduled to take effect on July 22, 2019, but was vacated by courts.

Federal law generally prohibits discrimination based on conscience or religious beliefs with respect to federally funded health care programs, including prohibiting recipients of certain federal funding from requiring health care providers to take actions that they find religiously or morally objectionable (e.g., providing referrals for abortions).

In 2019, HHS issued a final rule revising the applicable regulations, including imposing certification and cooperation requirements, as well as establishing additional enforcement provisions and penalties. However, this rule was later vacated by federal courts and never took effect. In 2024, HHS issued another final rule that generally applied a pre-2019 enforcement framework while also maintaining certain aspects of the 2019 rule (e.g., specifically designating HHS' Office for Civil Rights as the entity with the authority to handle relevant complaints).

The bill requires HHS to reinstate the 2019 rule in its entirety.

Supporting Access to Rural Community Hospitals Act of 2025

This bill temporarily allows additional hospitals to qualify as critical access hospitals (CAHs) that receive special payment under Medicare.

Currently, in order to qualify as a CAH under Medicare, a hospital must either (1) be located more than 35 miles (or 15 miles in mountainous regions or areas with only secondary roads) from another hospital, or (2) have been certified prior to January 1, 2006, by the state as a necessary provider of services in the area. Hospitals also must meet certain size and service requirements, including having no more than 25 acute care inpatient beds.

The bill allows, for one year, hospitals that are participating in the Rural Community Hospital Demonstration Program to also qualify as CAHs. (The program tests the feasibility of cost-based reimbursement for small rural hospitals that are too large to qualify as CAHs.)

John Lewis Equality in Medicare and Medicaid Treatment Act of 2026

This bill requires the Center for Medicare and Medicaid Innovation to test a payment model that addresses social determinants of health and health disparities, particularly with respect to minorities, underserved areas, and high-risk individuals. The bill also generally incorporates consideration of such factors into the selection, implementation, and evaluation of other models, including the decision as to whether to expand a model's duration and scope.