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The bill reduces and simplifies out-of-pocket ASC costs for Medicare enrollees and preserves provider revenue, but it raises federal Medicare spending and creates administrative burdens with potential downstream cost pressures on premiums or other payments.
Medicare beneficiaries (including seniors and retirees) will face lower and more predictable out-of-pocket costs for ambulatory surgical center (ASC) care because ASC coinsurance in a year is capped at the inpatient hospital deductible.
Ambulatory surgical centers and outpatient providers will receive payments to make up the difference between prior coinsurance and the capped amount, preserving provider revenue and billing predictability.
Medicare enrollees get simpler, more transparent financial liability for ASC services because coinsurance is tied to a known annual deductible amount.
Taxpayers and Medicare beneficiaries could face higher federal Medicare spending because HHS must pay ASCs the difference, increasing program outlays.
The funding shift could create upward pressure on premiums, increased cost-sharing elsewhere, or reduced payments in other parts of the system, affecting beneficiaries and taxpayers.
State governments, hospitals, and insurers will face added administrative complexity to track annual deductible caps across settings and implement payment adjustments starting Jan 1, 2026.
Based on analysis of 2 sections of legislative text.
Caps Medicare beneficiary coinsurance for certain ASC facility services at the annual inpatient hospital deductible and requires Medicare to pay the difference to the ASC.
Caps the amount a Medicare beneficiary must pay as coinsurance for facility services provided in an ambulatory surgical center (ASC) so it cannot exceed the annual inpatient hospital deductible for that year. If the normal coinsurance would be higher, Medicare reduces the beneficiary charge to that deductible and pays the ASC the difference. The change applies to ASC services furnished on or after January 1, 2026.
Introduced April 24, 2025 by Mike Kelly · Last progress April 24, 2025