Medicare Beneficiary Co-Pay Fairness Act
Sponsored By: Senator Bill Cassidy
Introduced
Summary
Caps Medicare coinsurance for ambulatory surgical center (ASC) facility services at the annual inpatient hospital deductible. This bill would limit beneficiary out-of-pocket coinsurance for those ASC facility services and require the Secretary to pay providers the difference so suppliers are fully compensated.
Show full summary
- Medicare beneficiaries: Older adults and other Medicare enrollees would face lower out-of-pocket costs for ASC facility charges because coinsurance would be capped at the yearly inpatient hospital deductible.
- Ambulatory surgical center suppliers: Medicare would pay suppliers an amount equal to the reduction so facilities receive the full payment despite the lower beneficiary coinsurance.
- Medicare program and administration: The change applies to services furnished on or after January 1, 2026 and directs the Secretary of Health and Human Services to implement the coinsurance cap and provider payment adjustments.
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Bill Overview
Analyzed Economic Effects
1 provisions identified: 1 benefits, 0 costs, 0 mixed.
Cap ambulatory surgery coinsurance for Medicare
This bill would cap what you pay for facility services at an ambulatory surgical center. If enacted, your yearly coinsurance for those ASC facility services would be limited to the inpatient hospital deductible for that year. Medicare would pay the ambulatory surgical center the difference between the usual coinsurance and the deductible. The cap would apply to services furnished on or after January 1, 2026.
Sponsors & CoSponsors
Sponsor
Bill Cassidy
LA • R
Cosponsors
Richard Blumenthal
CT • D
Sponsored 5/15/2025
Roll Call Votes
No roll call votes available for this bill.
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