Surprise! Recent Budget Law Accelerates Closing Of Medicare Part D Doughnut Hole
By Jessie Gibbons, Legislative Director
In February, after lawmakers allowed two government shutdowns to briefly take effect, Members of Congress finally passed the Bipartisan Budget Act of 2018. The massive budget deal set spending levels for two years and lifted the debt ceiling through March of next year. It came as a surprise to many in Washington – including The Senior Citizens League (TSCL) – and the agreement put an end to cycles of funding extensions that temporarily and irresponsibly funded the federal government for years.
Beyond funding the government and raising the debt ceiling, TSCL was pleased that the Bipartisan Budget Act included the following three improvements to the Medicare program:
- It eliminated the Independent Payment Advisory Board (IPAB). This fifteen-member board of unelected officials was created by the Affordable Care Act in 2010 to keep Medicare spending down when it exceeded a certain level. While that level was never surpassed and no members were ever appointed to the board, TSCL felt that it could have threatened access to quality medical care for Medicare beneficiaries since it had the power to cut payments to doctors and limit networks of providers. TSCL has advocated for bipartisan legislation for years that would have eliminated the IPAB, and we were pleased that the Bipartisan Budget Act did just that.
- It accelerated the closing of the “doughnut hole.” Under prior law, the Medicare Part D coverage gap or “doughnut hole” was set to close in 2020. The Bipartisan Budget Act accelerated the closing of the gap so that it will occur one year earlier, in 2019. Instead of paying a coinsurance rate of 30% in the “doughnut hole,” beneficiaries will pay 25%. And instead of brand-name drug manufacturers providing 50% discounts in the doughnut hole, they will begin providing 70% discounts. This means that more than one million Medicare Part D beneficiaries will pay less for their prescription drugs next year when they reach the gap in coverage.
- It closed the Medicare outpatient therapy cap. Before the passage of the Bipartisan Budget Act, Medicare coverage for various forms of outpatient therapy – including physical therapy and speech therapy – was arbitrarily capped at $1,500 per year. For years, lawmakers sought to repeal this cap since it limited the care older Americans could receive under Medicare. TSCL advocated tirelessly for Congressman Erik Paulsen’s (MN-3) bipartisan Medicare Access to Rehabilitation Services Act (H.R. 807), and we were thrilled that a similar provision was included in this year’s bipartisan budget agreement, repealing the therapy cap once and for all.
TSCL believes these three Medicare improvements were long overdue, and we were pleased that lawmakers reached across the aisle earlier this year to address them once and for all. For more information about the Bipartisan Budget Act and the other Medicare improvements TSCL is advocating for on Capitol Hill, visit our website at www.SeniorsLeague.org.
