Ambulatory surgery centers (ASCs) have a strong track record of high-quality care and positive patient outcomes. With this high-quality care also comes savings to patients and healthcare payers, providing a value to patients and the healthcare delivery system that is unmatched.
ASCs save Medicare approximately $7 billion a year. Future savings, however, are threatened by problematic Medicare policies that limit Medicare beneficiaries’ access to outpatient surgical care.
ASCA’s primary focus for the 119th Congress is the introduction and passage of the Medicare Beneficiary Co-Pay Fairness Act of 2025 (H.R. 3006/S. 1776). By enacting this legislation, Congress would ensure Medicare beneficiaries are not penalized for choosing the high-quality, lower-cost site of service that ASCs provide. For more information about the bill, read about the provisions below or see ASCA’s one-page summary of the copay cap issue.
Eliminate the Copay Penalty for Part B Services
Issue: A beneficiary typically has a coinsurance responsibility of 20 percent of the procedure cost when that procedure is performed in an ASC. When a beneficiary receives the same procedure in an HOPD, the copay is capped at the inpatient deductible amount, which is $1,676 for 2025, and the hospital is made whole by the Medicare program. This copay penalty limits patients’ access to care in ASCs and ultimately increases costs to Medicare, its beneficiaries and taxpayers.
This issue primarily impacts those without supplemental coverage—an area where a racial disparity in access has been observed, with only 40 percent of black beneficiaries being covered by supplemental insurance in contrast to 72 percent of white beneficiaries.
Solution: This provision of the bill applies the same framework that applies to HOPD services, capping a beneficiary’s copay and making the facility whole for the difference.