Summary

Caps how much a Medicare beneficiary can owe for certain ambulatory surgical center (ASC) facility services in a year by limiting their coinsurance to no more than the Medicare inpatient hospital deductible for that year. If the coinsurance would be higher, Medicare must reduce the coinsurance to the deductible amount and pay the ASC supplier the amount of that reduction. The change applies to services furnished on or after January 1, 2026. This amendment adjusts Medicare payment rules so beneficiaries face a predictable out-of-pocket cap for ASC facility services, while Medicare covers the difference to the ASC supplier.

• Limits Medicare beneficiary coinsurance for certain ASC facility services to at most the annual inpatient hospital deductible.
• When the usual coinsurance would exceed that deductible, Medicare reduces the coinsurance to the deductible amount.
• Medicare must pay the ASC supplier an amount equal to the reduction in beneficiary coinsurance.
• Applies to services furnished on or after January 1, 2026.
• Changes are implemented by amending the Medicare payment statute for Part B/ASC services.
• Likely reduces out-of-pocket costs for affected Medicare beneficiaries in those years.
• Likely increases Medicare program spending in cases where coinsurance reductions occur.
• Targets facility (ASC) coinsurance, not professional/provider fees billed separately.
• Does not create a new entitlement program; it changes payment rules within existing Medicare law.