Template Comments & Instructions: Changes to Medicare Eligibility for Immigrants in the Physician Fee Schedule Proposed Rule

Instructions

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The Centers for Medicare & Medicaid Services (CMS) has released a proposed rule within the CY 2027 Medicare Physician Fee Schedule to implement changes to Medicare eligibility for lawfully present immigrants. These eligibility changes were enacted as part of the Budget Reconciliation Act of 2025 (H.R. 1). Under H.R. 1, eligibility for all parts of Medicare is limited to U.S. Citizens, U.S. Nationals and three categories of lawfully present immigrants: Lawful Permanent Residents (green card holders), certain Cuban or Haitian entrants, and people residing in the U.S. under the Compact of Free Association (COFA). All other lawfully present immigrants, such as people with Temporary Protected Status, refugees and asylees, are no longer eligible. H.R.1 did not alter the immigration status of newly ineligible enrollees, and this group remains eligible for Social Security benefits including Supplemental Security Income (SSI), retirement and disability payments.

Your comments are needed to create a strong record and ensure that your support or concerns with how the law is being implemented and how it will affect the communities you serve are heard.

Justice in Aging has created template comments to guide you. The primary focus is on the Medicare eligibility changes for immigrants. We have also included an optional section urging CMS to continue consideration of expanding coverage of medically necessary dental services for all Medicare enrollees. For each area for commenting, we have provided a summary of the proposal and examples of what would be helpful to include in your comments. This document also provides a Glossary below of terms and acronyms and additional resources.

Overall guidelines for commenting:

• Address as few or as many areas as you wish. Even one or two examples showing the impact of one of the proposed changes would help. Organizations that have the bandwidth to go deeper—please do!
• If you have client stories or personal experiences with the proposal that support your comments, please make sure to include them! Please make sure to leave out details that could identify individuals.
• CMS values comments that are unique. Please write comments in your own words and include examples even if we have not prompted them.
• Page numbers refer to the federal register page number printed at the top of the PDF page.

Comment Deadline: September 14, 2026. Submit comments online here.

Glossary

• Grace Period Population: Individuals who were entitled to and enrolled in Medicare as of July 4, 2025, and who are no longer eligible based on the H.R. 1 Medicare changes.
• Outside of the Grace Period Population: Individuals who enrolled in Medicare after July 4, 2025, and who are no longer eligible based on the H.R. 1 Medicare changes.
• Special Enrollment Period (SEP): The proposed rule creates a 6-month period allowing individuals who regain Medicare eligibility to re-enroll in Medicare Part A and Part B. CMS proposes a 2-month SEP for enrollment in Medicare Advantage and Part D coverage following reinstatement in Medicare Part A and or B.
• Dual Eligible Special Needs Plans (D-SNPs): D-SNPs are a subset of Medicare Advantage plans that specifically serve individuals dually enrolled in Medicare and Medicaid. D-SNPs are subject to federal oversight and must comply with Medicare Advantage regulations and guidance. Each D-SNP sponsor must enter into a contract with the state Medicaid agency in which the D-SNP operates. The extent to which D-SNPs coordinate with Medicaid varies. Coordination Only, Highly Integrated, Fully Integrated, and Applicable Integrated plans are all types of D-SNPs with different integration and coordination requirements. Read more in Dual Eligible Special Needs Plans (D-SNPs): What Advocates Need to Know.

Additional Resources

Template

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September 14, 2026

Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attention: CMS-1848-P
P.O. Box 8016, Baltimore, MD 21244-8016.

Submitted electronically via regulations.gov

Re: Medicare and Medicaid Programs; CY 2027 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare Prescription Drug Inflation Rebate Program (CMS-1848-P)

[Organization] appreciates the opportunity to provide comments on the above-referenced Notice of Proposed Rule Making. [Describe your organization’s mission and connection to Medicare and/or older immigrants and immigrants with disabilities].

[Organization] has many concerns about the proposals in the above-referenced Notice of Proposed Rulemaking. These comments specifically address the impact the changes would have on the individuals that our organization serves, including older adults and persons with disabilities who are dually eligible for Medicare and Medicaid. [Include additional information about what you believe CMS should prioritize, what concerns your organization has with the proposed rule, and the impact of these policies on the older immigrant population.]

1. Noticing Framework for Medicare Terminations

Summary: CMS proposes a process for categorizing and sending Medicare termination notices to individuals who do not meet the new Medicare eligibility requirements based on their immigration status. SSA will send a preliminary notice and termination notice to people in the grace period population. All other impacted individuals outside of the grace period population will receive only a single termination notice.

• In section III.E.2b. on page 43999 (entitled, “Termination of Entitlement for Individuals Who Were Entitled to, or Enrolled for, Medicare as of July 4, 2025 (“Grace Period Population”)), CMS proposes that individuals enrolled in Medicare as of July 4, 2025, categorized as the “grace period population,” who are no longer eligible for Medicare based on their immigration status would be identified and notified with a preliminary notice by the Social Security Administration (SSA) that they no longer meet Medicare eligibility criteria. SSA would send this population a second notice at the end of December 2026 with information about the termination of Medicare enrollment effective February 1, 2027. The notice would inform individuals of their appeal rights under existing appeals regulations.     
• In section III.E.2c. on page 44000 (entitled, “Proposed Termination Process for Certain Noncitizens Entitled to, or Enrolled for, Medicare Who Were Not Identified and Notified by the SSA (Outside of the “Grace Period” Population)), CMS proposes the process to end enrollment for all other individuals who enrolled in Medicare after July 4, 2025, outside of the grace period, and who do not meet the new Medicare eligibility criteria. Individuals who do not meet the new Medicare eligibility criteria would be sent a termination notice from SSA, and Medicare enrollment would terminate at the end of the month following the month in which the notice is dated. The termination of Medicare enrollment would occur prospectively and not before January 1, 2027, the effective date of the rule, if finalized as proposed.  
• In section III.E.4. on page 44003 (entitled, “Limiting Coverage Under Medicare Part C, Medicare Part D, and Cost Plans to Certain Individuals), CMS proposes disenrollment procedures for individuals who lose Medicare eligibility due to immigration status from enrollment in Medicare Advantage, Part D or Cost plans. CMS will notify plans of disenrollment when individuals lose their entitlement for Medicare. Medicare plan disenrollment will be prospective and effective the first day of the month following the last month of entitlement to Part A or Part B. Plans have the option and are not required to send impacted enrollees a written notice of disenrollment due to loss of Medicare entitlement. 

Helpful Areas to Comment

• Support for the timely mailing of the preliminary notice sent by the Social Security Administration (SSA) to the grace period population by mid-September 2026.
• Support for a preliminary notice also be mailed to individuals who enrolled in Medicare outside of the grace period. This population includes individuals who may be mistakenly identified as ineligible for Medicare. SSA immigration records may not be updated, and impacted individuals can avoid improper termination by updating their immigration status with SSA after being prompted by the preliminary notice.
  • Insert examples of people being mistakenly identified as not lawfully present prior to H.R. 1 passing in July 2025. These can include examples where people with Medicare were found ineligible for Medicare payment of services and examples of people erroneously losing Medicaid coverage.
• Support for CMS requiring Medicare Advantage (MA) plans, Prescription Drug Plans (PDPs), Medicaid Managed Care Organizations (MCOs), Cost plans, and Programs of All Inclusive Care for the Elderly (PACE) organizations to send multiple (ideally at least three) notices to ensure impacted enrollees are fully informed of their loss of coverage. People may not connect the SSA termination notice with the health care they receive through these other delivery systems.
• Support for CMS providing community-based organizations with educational resources about the Medicare changes and Medicare termination notices (e.g., State Health Insurance Assistance Programs (SHIPs), Aging and Disability Resource Centers (ADRCs), Area Agencies on Aging (AAAs), etc.).
• Support for CMS educating Medicare providers about the Medicare changes (e.g., via the Medicare Learning Network (MLN) articles).
• Support for Medicare termination notices to follow Medicare and Section 1557 language access guidelines. 
• Early and multiple notices are important because people need time to prepare for the loss of Medicare and make health care decisions. This includes refilling prescriptions, completing scheduled tests and other diagnostic screenings, schedule and attend appointments, arrange surgeries, consult with medical providers about their course of treatment, and if possible, assess alternative coverage options. These barriers are even higher for individuals with Limited English Proficiency (LEP).
  • Insert examples or stories of dually eligible individuals with high health care needs managing chronic conditions, provider visits, and prescription medication lists, and who are losing Medicare eligibility.
  • Insert examples of clients with LEP facing barriers to understanding notices or scheduling appointments or experiencing delays in care because of difficulty getting an interpreter or finding providers that speak their language.
• Without multiple notices and other outreach strategies, impacted individuals may not understand Medicare is ending until after coverage has already terminated. This could have life-threatening consequences.
  • Insert examples of older adults and people with disabilities learning about their health and prescription medication coverage termination only after they tried to refill a prescription at the pharmacy, or similar situations.

2. Proposed Termination Process for Certain Noncitizens Outside of the “Grace Period” Population

Summary: The PFS does not address protections for people who were erroneously enrolled in Medicare after July 4, 2025, even though they were not eligible based on their immigration status. Immigrants who are no longer eligible but turned 65 or reached the end of their 24-month Social Security Disability Waiting period in the past year may have been automatically enrolled in Medicare Part A and B. They may have paid Part B premiums (or had them paid by Medicaid) and received health care that Medicare paid for. The PFS does not discuss procedures and policies to ensure these individuals are held harmless, given SSA’s delay in implementing screening procedures to prevent enrollment of individuals no longer eligible under H.R. 1.

Helpful Areas to Comment

• Support for CMS to make explicit that people erroneously enrolled into Medicare after July 4, 2025, despite not being one of the four remaining eligible categories, will be held harmless for any erroneous enrollment.
• Because SSA has not implemented screening procedures to prevent ineligible immigrants from newly enrolling into Medicare, CMS should hold this group of people harmless and cannot require they repay any Medicare services received.
• Individuals who enrolled in Medicare outside of the grace period include people automatically enrolled into Medicare. They should not be punished because of SSA’s delay in implementing screening procedures. For example, people already receiving Social Security retirement benefits or people who reached their 24-month Social Security Disability Insurance waiting period.
  • Insert examples of clients enrolled into Medicare after July 4, 2025, by SSA.

3. Special Enrollment Period for Individuals who Gain or Regain Medicare Eligibility

Summary: In section III.E.3. on page 44002, CMS proposes to provide a 6-month special enrollment period (SEP) for individuals who are disenrolled from Medicare and later regain eligibility due to an immigration status change, or individuals newly meeting Medicare immigration requirements. The SEP would begin in the month in which the individual contacts SSA, and provides documentation to establish Medicare eligibility, and would end 6-months later. CMS proposes a retroactive effective date for up to 6 months for premium-free Part A for individuals and a standard prospective-only effective date for enrollment into premium Part A and Part B. Some individuals have to pay a monthly premium for Part A because they do not have the required Social Security work quarters.

Helpful Areas to Comment

• Opposition to the proposed length of the 6-month SEP. Support for a longer SEP to give impacted individuals more time to re-enroll in Medicare. A longer SEP period could be indefinite or, at a minimum, 12 months.
• A longer SEP period would ease the burden on enrollees to reach out to SSA, especially because it can be difficult to speak with SSA and get in-person appointments, which are required to establish citizenship/immigration status.
  • Insert examples of SSA capacity issues including long wait times for in-person visits.
  • Insert stories of Medicare enrollees with extended wait times for in-person visits at SSA.
• Opposition to the prospective-only effective date for premium Part A and Part B. Support for CMS giving impacted individuals with premium Part A and B the choice of retroactive coverage. All individuals gaining, or regaining, Medicare eligibility should have the option of either a prospective or retroactive effective date for premium Part A and Part B.
• A retroactive coverage date is important to maximizing health coverage and avoiding medical debt.
  • Insert examples of people who experience health emergencies or are in the midst of ongoing care like cancer treatment when they first become eligible for Medicare and it may take time for them to gather documentation and get an appointment at SSA to get their Medicare coverage started.
• Support for CMS providing an Initial Enrollment Period (IEP) for people qualifying for Medicare for the first time similar to other new Medicare enrollees.
• Support for CMS providing community-based organizations with educational resources about the SEPs (e.g., SHIPs, ADRCs, AAAs, etc.).

4. Disenrollment Processes for Medicare Advantage, Medicare Part D, and Cost Plans for People Who Lose Medicare Eligibility

Summary: In section III.E.4. on page 44003 (entitled, “Limiting Coverage Under Medicare Part C, Medicare Part D, and Cost Plans to Certain Individuals), CMS proposes disenrollment procedures for individuals who lose Medicare eligibility due to immigration status from enrollment in Medicare Advantage, Part D or Cost plans. Medicare plans have the option but are not required to send impacted enrollees a written notice of disenrollment due to loss of Medicare entitlement. CMS will notify plans of disenrollment when individuals lose their entitlement for Medicare. Medicare plan disenrollment will be prospective and effective the first day of the month following the last month of entitlement to Part A or Part B.

Helpful Areas to Comment

• Support for CMS to work with Medicare plans, Medicaid Managed Care plans and PACE organizations to prepare standard telephone scripts to explain the Medicare changes and provide referral resources to local community-based resources (e.g., SHIPs, ADRCs, AAAs, etc.).
• Support for CMS to require Medicare plans, Medicaid Managed Care plans, and PACE to provide written notice of their plan termination to impacted enrollees, as recommended in section 1 above. Additional notice and outreach are important because the SSA termination notice may not be enough for people to understand that the care they receive through their MA plan, PDP plan, or PACE is also ending.
• Insert examples of supplemental benefits, care coordination, or case management clients receive through Medicare plans (including D-SNPs) or PACE plans.

5. Impacts of the Collection of Information Related to Limiting Medicare Enrollment

Summary: CMS provides estimations of the number of people projected to lose Medicare eligibility, and requests comment on its calculation of the estimated cost for the addition and use of the new SEP category for Medicare re-enrollment.

• In section V.B.4. on page 44222 (entitled, “Information Collection Requirements (ICRs) Regarding Limiting Medicare Coverage of Certain Individuals), CMS requests comment on the burden assumptions for the addition of the new SEP category to the CMS-10797 form. CMS projects approximately 3,200 individuals annually will utilize the SEP to re-enroll in Medicare following a change in their citizenship, nationality, or immigration status. This number is 10% of the estimated number of individuals projected to lose coverage provided by the Office of the Actuary (OACT).
• In section VII.F.6. on page 44251 (entitled, “Limiting Medicare Coverage of Certain Individuals), CMS provides an estimation of 32,000 individuals projected to lose coverage beginning in 2027 due to the Medicare changes. This approximation is based on the OACT figure derived from a 2025 Pew Research study on race and ethnicity in the United States and a Congressional report authored by the Department of Homeland Security (DHS).