Sponsors (2)
The bill lowers and standardizes out-of-pocket costs for Medicare beneficiaries using ASCs and protects provider reimbursement, but it raises Medicare program costs (borne by taxpayers) and could prompt provider behavior changes or future premium pressures.
Medicare beneficiaries will pay less out-of-pocket for ambulatory surgical center (ASC) facility services when coinsurance would otherwise exceed the inpatient hospital deductible (coinsurance effectively capped at the deductible).
Medicare beneficiaries and providers gain a predictable cost-sharing cap tied to the annual deductible (simplifying patient cost expectations and administrative billing beginning Jan 1, 2026).
ASC suppliers and hospitals are reimbursed for the difference when coinsurance is reduced, so providers receive payment rather than absorbing the cut.
Taxpayers and the Medicare program will incur higher costs because Medicare pays suppliers the difference between the higher coinsurance and the deductible cap.
Slightly higher Medicare spending could put upward pressure on Part A/B premiums or otherwise strain program financials over time, affecting beneficiaries and taxpayers.
Hospitals and ASCs may alter service site selection or billing practices to maximize reimbursements, creating administrative complexity or shifting costs in ways that could be inefficient or unintended.
Based on analysis of 2 sections of legislative text.
Caps beneficiary coinsurance for certain ASC facility services at the annual inpatient hospital deductible and directs Medicare to pay the supplier the reduction.
Official title: Amend title XVIII of the Social Security Act to limit the coinsurance amount for certain services furnished in an ambulatory surgical center.
Introduced May 15, 2025 by Bill Cassidy · Last progress May 15, 2025
Caps how much a Medicare patient can be charged for ambulatory surgical center (ASC) facility coinsurance when that coinsurance would exceed the inpatient hospital deductible for the year. If the ASC coinsurance would be higher, the Secretary must reduce the coinsurance to match the inpatient deductible and pay the ASC the difference so the supplier is made whole; changes apply to services on or after January 1, 2026.