Medicare caps outpatient surgery costs for seniors, guarantees ASC revenue
S. 1776 — Medicare Beneficiary Co-Pay Fairness Act · Filed by Bill Cassidy (R-LA) · 1 cosponsor · Introduced May 15, 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 (outpatient surgery facilities). If the normal coinsurance would exceed the annual inpatient hospital deductible, the bill reduces the patient's coinsurance to match that deductible amount and requires Medicare to pay the difference to the surgical center. The change takes effect January 1, 2026.
Why we flagged it
The bill's sole operative mechanism is a ceiling on patient coinsurance for outpatient surgical procedures, paired with a corresponding Medicare payment to the facility. It is a straightforward beneficiary-protection measure with a secondary effect on facility revenue.
What the text implies
- The bill guarantees ambulatory surgical centers (ASCs) will receive payment for any coinsurance reduction, creating a de facto revenue floor for these facilities when coinsurance would otherwise exceed the inpatient deductible.
- By capping coinsurance at the inpatient deductible level, the bill may shift cost-sharing incentives: beneficiaries face identical out-of-pocket exposure whether they use an ASC or an inpatient hospital, potentially increasing ASC utilization if quality and convenience are comparable.
The full analysis lists 3 implications of this text.
Who stands to gain
ambulatory surgical centers (ASCs); surgical facility operators