Medicare Beneficiary Co-Pay Fairness Act

This legislation proposes an amendment to title XVIII of the Social Security Act, aiming to introduce a new limitation on the coinsurance amount for specific services furnished in ambulatory surgical centers (ASCs) under Medicare. The core purpose is to alleviate the financial burden on beneficiaries by capping their out-of-pocket expenses for certain surgical procedures performed in these settings. Under the bill's provisions, if the application of existing rules would result in a beneficiary's coinsurance for ASC facility services exceeding the annual inpatient hospital deductible , the Secretary of Health and Human Services must reduce that coinsurance to match the deductible. Furthermore, the Secretary is directed to compensate the ASC for the amount of this reduction, ensuring providers are not disadvantaged. These changes are scheduled to apply to all services furnished on or after January 1, 2026, providing a clear effective date for this new financial protection.