Limit Ambulatory Surgery Coinsurance

Full Title:
To amend title XVIII of the Social Security Act to limit the coinsurance amount for certain services furnished in an ambulatory surgical center.

Summary#

This bill would change a Medicare rule to limit the amount of coinsurance charged for certain facility services provided during a surgical procedure at an ambulatory surgical center (ASC). If the coinsurance for those ASC facility services would be more than the inpatient hospital deductible for that year, the bill requires the coinsurance to be reduced to equal that inpatient hospital deductible. The Secretary must pay the ASC supplier an amount equal to that reduction. The change applies to services furnished on or after January 1, 2026.

What it means for you#

  • If you have Medicare and get a surgical procedure at an ambulatory surgical center, you would not be charged coinsurance for the ASC facility portion that is higher than the inpatient hospital deductible for that year.
  • Ambulatory surgical centers that would otherwise get higher coinsurance payments would receive from Medicare an amount equal to the reduced coinsurance.

Expenses#

No publicly available information on projected costs or savings. The bill text requires the Secretary to pay suppliers an amount equal to any coinsurance reduction, but it does not include cost estimates.

Proponents' View#

No publicly available information.

Opponents' View#

No publicly available information.