A House bill introduced October 22 would extend Medicare’s Extra Help program to low-income Part D enrollees in Puerto Rico and the other U.S. territories, who are shut out of it today. H.R. 10874, the Medicare Low Income Subsidy Equality Act of 2026, would make premium and cost-sharing subsidies available to those enrollees. It has only been referred to committee.
What H.R. 10874 would change
Resident Commissioner Pablo Jose Hernandez, a Democrat who represents Puerto Rico, introduced the bill. Del. James Moylan, a Republican from Guam, and Rep. Darren Soto, a Florida Democrat, signed on as original cosponsors. The House’s bill-status record lists the title as an act to amend Titles XVIII and XIX of the Social Security Act.
Those two titles are Medicare and Medicaid. The official title says the amendment would “make premium and cost-sharing subsidies available to low-income Medicare part D beneficiaries” in the territories. The tracker entry carries no summary yet, so thresholds, start dates and costs are not public.
On October 22 the bill was referred to the Energy and Commerce Committee and, in addition, to Ways and Means, for a period the Speaker will set. Referral is the only action on the record. No hearing, markup or vote has been announced.
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Each committee takes the provisions inside its jurisdiction. The 119th Congress is the current one, and bills that never get a committee vote simply expire at its end. Supporters would need action from both committees before the full House could vote.
Why territory residents do not get Extra Help now
Extra Help, formally the Part D low-income subsidy, helps people with limited income and resources lower Part D costs such as deductibles and copays. Social Security runs the application and says people can apply before or after enrolling in a drug plan. It asks for financial information as part of the application.
Residents of the territories are barred from the subsidy by law. A Congressional Research Service brief explains that Section 1935(e) of the Social Security Act gives the territories federal funding “in lieu of” their residents being eligible for low-income subsidies under Part D.
That money is capped, and the territories may use it only to provide Medicaid drug coverage for low-income Medicare beneficiaries. A resident of Puerto Rico who would qualify for Extra Help in Ohio or Florida gets whatever the territory’s capped Medicaid program provides instead. The CRS brief gives no dollar value for the drug funding itself.
The idea is not new. A 2019 bill from Soto, Donna Shalala, Jenniffer Gonzalez-Colon and Stephanie Murphy, H.R. 4666, sought the same eligibility starting in 2021. Soto’s release said the territorial funding can be substantially less than what the subsidy would provide, and that 3.2 million American citizens live in Puerto Rico, per Gonzalez-Colon.
What the bill does not say yet
A reader asking whether a Puerto Rico resident would qualify cannot get an answer from the bill’s public record. The tracker entry shows no income or asset limits. In the states, Social Security decides Extra Help eligibility on income and resources, and the territorial version could follow that model or a different one.
Nor does the public record carry a cost estimate. The territories now receive capped federal money, which the CRS brief describes as the Enhanced Allotment Program, and the bill’s reference to Title XIX suggests the two systems would have to be reconciled. The tracker does not explain how.
The 2019 bill offers a clue to the sponsors’ approach but is not the same bill. It targeted 2021 as the start, and Soto’s release at the time listed what the subsidy covers: Part D premiums, deductibles and coinsurance, the old coverage gap and the late-enrollment penalty. The 2026 version has no start date in the public record, so any benefit date would be a guess.
Who could actually use Extra Help today
Medicare enrollees in the 50 states can apply to Social Security now, online or by calling 1-800-772-1213 on weekdays from 8 a.m. to 7 p.m. in most time zones. TTY users call 1-800-325-0778. Medicare.gov has additional details on the program, according to the agency.
Territory residents are not left without drug help under the current structure, but it runs through the territory’s Medicaid agency and is limited by the federal cap. Anyone in Puerto Rico, Guam, the Virgin Islands, American Samoa or the Northern Mariana Islands should ask the local Medicaid office about drug coverage rules.
Soto’s 2019 statement framed the stakes this way: “No senior should ever have to forego vital, life-saving healthcare just because of where they live.” The 2026 bill returns to that argument with a Republican delegate from Guam on board, but it has not moved past referral.
For now, H.R. 10874 changes nothing about what a Medicare enrollee pays at the pharmacy counter in Puerto Rico or anywhere else. The next step would be committee action, and none has been announced.
Need drug-cost help while this bill sits in committee?
H.R. 10874 has no hearing or vote scheduled, so nothing changes for a Medicare enrollee’s pharmacy bills this year. In the 50 states and D.C., the help that exists today still has to be applied for, and each state sets its own limits and forms.
The Medicare Cost & Coverage Protection Kit includes 51 state Medicare cost-help packs, the new Part D out-of-pocket cap and a medication and cost tracker. Part 3 of the kit, Get Help Paying, lays out the programs that pay premiums and cut drug bills for readers in a state or helping a relative there.
Get the state cost-help packs and Part D cap tracker →
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This article was produced with AI assistance and edited for accuracy against the sources linked above.
