The delayed Medicare Savings Program rule means low-income Alzheimer's families keep current cost help but miss automatic enrollment until fiscal year 2035. Medicare Savings Programs, state-run programs that pay Medicare premiums and in most cases cost-sharing, will keep old application rules. According to the Centers for Medicare & Medicaid Services, a 2023 rule would have made enrollment automatic for many people and reused drug-subsidy records. According to the Commonwealth Fund, Congress then blocked those enrollment steps through September 30, 2034.
Medical information disclaimer: This article is for general educational purposes only and does not provide medical advice, diagnosis, or treatment. Always consult a physician or other qualified health professional about symptoms, medications, tests, or treatment decisions.
Official resources:
- Read the official notice from CMS — Use this primary source to verify the official announcement.
- Read the official guidance from CMS — Use this primary source to verify the official guidance.
Table of Contents
- What was supposed to get easier?
- What did the new law delay?
- Why does this matter for dementia families?
- What should families do now?
- How to keep help you already have?
What was supposed to get easier?
The 2023 final rule was titled Streamlining Medicaid; Medicare Savings Program Eligibility Determination and Enrollment. According to the Centers for Medicare & Medicaid Services, it required automatic enrollment for many SSI recipients. SSI means Supplemental Security Income.
Those enrollees would enter Qualified Medicare Beneficiary coverage, one MSP category. The Centers for Medicare & Medicaid Services estimated coverage would become affordable for about 860,000 more people, detailed in the 2023 final rule notice. It also projected savings of nearly 19 million paperwork hours for applicants each year. State work would fall by over 2 million hours each year.
What did the new law delay?
The 2025 reconciliation law H.R. 1, signed July 4, 2025, bars health officials from carrying out those MSP enrollment steps through September 30, 2034. The Commonwealth Fund reports the effect is a delay until fiscal year 2035, explained in Fund analysis.
The Congressional Budget Office estimates 1.3 to 1.38 million fewer beneficiaries will have MSP plus Medicaid coverage by 2034. The same analysis cites a $66 billion federal spending reduction over 2025-2034 from the delay. KFF reports the freeze covers only specified enrollment and eligibility provisions. Existing MSP benefits continue without the planned simplification and retention gains.
Why does this matter for dementia families?
The Alzheimer's Association reports total lifetime care cost per person with dementia is about $405,262, noted in its caregiver-month report. The group says roughly 70% falls on families as unpaid care plus out-of-pocket spending. Even small Medicare bills can compound that load.
The Centers for Medicare & Medicaid Services set 2026 Part B premiums at $202.90 per month, listed in the 2026 Medicare costs fact sheet. The Part B deductible is $283 per year plus generally 20% coinsurance. The Part A hospital deductible is $1,736 per benefit period.
What should families do now?
The Center for Medicare Advocacy advises low-income Alzheimer's families to still apply separately for MSPs and Part D Extra Help. Use your state Medicaid agency or State Health Insurance Assistance Program.
Data matching and automatic enrollment will not move forward during the moratorium. Bring these items when you seek help: Ask the counselor to file both applications and note deadlines. Keep copies because the old renewal rules still apply.
- Medicare card and proof of income and assets.
- Part D drug list and pharmacy bills.
- Any denial or renewal letter and caregiver contact.
How to keep help you already have?
KFF reports current MSP coverage stays in place during the delay. The planned retention improvements will not start. That makes missed mail or a missed renewal more risky.
Open every Medicaid and Social Security letter quickly. If income or address changes, tell the state agency at once. Get free local help from the State Health Insurance Assistance Program before a deadline passes.
