Medicare caps ASC coinsurance, raising facility reimbursement
H.R. 3006 — To amend title XVIII of the Social Security Act to limit the coinsurance amount for certain services furnished in an ambulatory surgical center. · Filed by Mike Kelly (R-PA) · 21 cosponsors · Introduced Apr 24, 2025 · Referred to committee
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What it does
This bill caps the coinsurance (patient cost-sharing) that Medicare beneficiaries must pay for certain surgical procedures performed in ambulatory surgical centers (ASCs). When the coinsurance would exceed the annual inpatient hospital deductible, Medicare reduces the patient's out-of-pocket cost to match that deductible amount and reimburses the ASC facility for the difference. The change takes effect January 1, 2026.
Why we flagged it
The bill's operative mechanism is a direct cost-control measure for beneficiaries paired with a reimbursement increase for ASC facilities. It is a targeted amendment to Medicare payment policy, not a broad reform or deregulation.
What the text implies
- By capping coinsurance at the inpatient deductible, the bill may incentivize shift of procedures from inpatient hospital settings to ASCs, potentially fragmenting care and reducing hospital revenue.
- The bill guarantees ASC reimbursement for the coinsurance reduction, creating a new cost to Medicare with no spending cap or sunset; long-term fiscal impact depends on procedure volume and pricing trends.
The full analysis lists 3 implications of this text.
Who stands to gain
ambulatory surgical centers (ASC operators and owners); Medicare beneficiaries (lower out-of-pocket costs)