May 15, 2025
Alexandria, VA—Today, Senators Richard Blumenthal (D-CT) and Bill Cassidy, MD (R-LA), introduced the Medicare Beneficiary Co-Pay Fairness Act of 2025. The Ambulatory Surgery Center Association (ASCA) strongly supports this bill, which would reduce beneficiary costs by capping the maximum Medicare copayment for procedures performed in ambulatory surgery centers (ASC) at the inpatient deductible.
The Senate introduction of the bill comes 21 days after the House introduction. Representatives Mike Kelly (R-PA), Robert Menendez Jr. (D-NJ), Troy Balderson (R-OH) and John Larson (D-CT) introduced the House bill on April 24.
“If your grandmother depended on Medicare for life-saving treatment, you would not want to hear that Medicare was cutting corners,” Senator Cassidy said. “This bill makes costs fairer for patients while keeping the quality of care high.”
ASCA Chief Executive Officer Bill Prentice underscored the urgency of this legislative action. “Surgery centers are the high-quality and cost-effective site of service for an ever-growing number of outpatient procedures,” said ASCA Chief Executive Officer Bill Prentice. “The current absence of a limit on Medicare beneficiary out-of-pocket costs in ASCs, despite one being in place for procedures performed in hospitals, unintentionally drives patients to higher-cost care settings.”
Medicare beneficiaries who receive treatment in either an ASC or hospital outpatient department (HOPD) are typically responsible for 20 percent of their cost of care. In HOPDs, this 20 percent copay is capped at the hospital inpatient deductible amount, which is $1,676 for 2025. In ASCs, however, there is no copay cap. As a result, Medicare patients treated in an ASC face higher copays for approximately 183 procedures.
Moreover, when the copay cap is applied in an HOPD, the hospital is made whole, meaning that Medicare pays the hospital the difference between what 20 percent of the procedure would have yielded and the capped amount of $1,676. Since Medicare reimburses HOPDs significantly more than ASCs for virtually every procedure, current policy incentivizes beneficiaries to choose the higher-cost site of care, adding unnecessary costs to the Medicare program.
“The Medicare Beneficiary Co-Pay Fairness Act of 2025 will allow beneficiaries to receive care in the ASC setting without paying more for the procedure. We thank the sponsors for introducing this important bill,” Prentice said.
More than 6,300 Medicare-certified ASCs currently operate in the US, performing a wide variety of outpatient procedures. Surgery centers represent a significant source of savings potential for both patients and payers because they can perform procedures with greater efficiency and at a lower cost than hospitals. According to a 2020 analysis from KNG Health Consulting, surgery centers are projected to reduce Medicare program costs by $73.4 billion from 2019 to 2028.