To amend title XVIII of the Social Security Act to limit the coinsurance amount for certain services furnished in an ambulatory surgical center.
Sponsored By: Representative Kelly (PA)
Introduced
Summary
Caps Medicare coinsurance for certain ambulatory surgical center (ASC) facility services at the annual inpatient hospital deductible. It would require Medicare to pay ASCs the difference when a beneficiary's coinsurance would otherwise exceed that deductible.
Show full summary
- Families and beneficiaries: For ASC facility services covered under section 1833(a)(1)(G), a patient's coinsurance in a year would not exceed that year's inpatient hospital deductible.
- Ambulatory surgical centers and suppliers: Medicare would reduce the beneficiary's coinsurance to the deductible amount and pay the supplier the difference between the original coinsurance and the cap.
- Timing and scope: The change would apply only to facility services described in section 1833(a)(1)(G) and to services furnished on or after Jan. 1, 2026.
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Bill Overview
Analyzed Economic Effects
1 provisions identified: 1 benefits, 0 costs, 0 mixed.
Cap on Medicare surgery center coinsurance
If enacted, this bill would cap what you pay in coinsurance for certain Medicare surgery center facility fees. Starting for care on or after January 1, 2026, if your coinsurance would be higher than the inpatient hospital deductible for that year, you would pay only up to that deductible. Medicare would pay the surgery center the rest. This would apply only to specific ambulatory surgery center facility services covered by Medicare. It would not change other Medicare cost-sharing rules.
Sponsors & CoSponsors
Sponsor
Kelly (PA)
PA • R
Cosponsors
Menendez
NJ • D
Sponsored 4/24/2025
Balderson
OH • R
Sponsored 4/24/2025
Larson (CT)
CT • D
Sponsored 4/24/2025
Bost
IL • R
Sponsored 7/15/2025
Mann
KS • R
Sponsored 7/22/2025
Ross
NC • D
Sponsored 8/12/2025
Gottheimer
NJ • D
Sponsored 8/26/2025
Lieu
CA • D
Sponsored 9/16/2025
Joyce (PA)
PA • R
Sponsored 9/26/2025
Tlaib
MI • D
Sponsored 9/30/2025
Smith (NE)
NE • R
Sponsored 10/24/2025
Rutherford
FL • R
Sponsored 10/24/2025
Veasey
TX • D
Sponsored 11/10/2025
Rulli
OH • R
Sponsored 11/17/2025
Owens
UT • R
Sponsored 12/1/2025
Miller (WV)
WV • R
Sponsored 12/10/2025
Bynum
OR • D
Sponsored 12/19/2025
Neguse
CO • D
Sponsored 1/7/2026
McBride
DE • D
Sponsored 1/21/2026
Yakym
IN • R
Sponsored 2/9/2026
Sewell
AL • D
Sponsored 2/9/2026
Roll Call Votes
No roll call votes available for this bill.
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