Medicare Beneficiary Co-Pay Fairness Act
Medicare Beneficiary Co-Pay Fairness Act would amend the Medicare Part B framework (title XVIII of the Social Security Act) to limit how much coinurance a beneficiary must pay for certain ambulatory surgical center (ASC) facility services. Specifically, if applying the current coinsurance rule would produce a beneficiary coinsurance greater than the inpatient hospital deductible for that year, the bill requires the coinsurance to be reduced to the deductible amount, and the Secretary would pay the provider the amount of that reduction. The provision would take effect for services furnished on or after January 1, 2026. The bill was introduced in the Senate by Sen. Cassidy (joined by Sen. Blumenthal). In short, the bill aims to cap beneficiary out-of-pocket costs for certain ASC facility services at the inpatient deductible amount, with Medicare offsetting the provider for the reduction.
Key Points
- 1Creates a new limitation (subsection (ee)) on coinsurance for certain ASC facility services under Medicare Part B (Title XVIII).
- 2If the usual coinsurance would exceed the inpatient hospital deductible for the year, the coinsurance is reduced to the deductible amount.
- 3The Secretary must pay the provider the amount of the reduction, effectively offsetting the decreased patient coinsurance.
- 4Applies to services described in the existing facility services rule (a)(1)(G), but only when the coinsurance would exceed the inpatient deductible.
- 5Effective date: the change applies to services furnished on or after January 1, 2026.