Legis Daily

Medicare Beneficiary Co-Pay Fairness Act

USA119th CongressS-1776| Senate 
| Updated: 5/15/2025
Bill Cassidy

Bill Cassidy

Republican Senator

Louisiana

Cosponsors (1)
Richard Blumenthal (Democratic)

Finance Committee

  • Introduced
  • In Committee
  • On Floor
  • Passed Chamber
  • Enacted
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.
View Full Text

Suggested Questions

Get AI-generated questions to help you understand this bill better

Timeline
May 15, 2025
Introduced in Senate
May 15, 2025
Read twice and referred to the Committee on Finance.
  • May 15, 2025
    Introduced in Senate


  • May 15, 2025
    Read twice and referred to the Committee on Finance.

Health

Related Bills

  • HR 119-3006: To amend title XVIII of the Social Security Act to limit the coinsurance amount for certain services furnished in an ambulatory surgical center.

Medicare Beneficiary Co-Pay Fairness Act

USA119th CongressS-1776| Senate 
| Updated: 5/15/2025
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.
View Full Text

Suggested Questions

Get AI-generated questions to help you understand this bill better

Timeline
May 15, 2025
Introduced in Senate
May 15, 2025
Read twice and referred to the Committee on Finance.
  • May 15, 2025
    Introduced in Senate


  • May 15, 2025
    Read twice and referred to the Committee on Finance.
Bill Cassidy

Bill Cassidy

Republican Senator

Louisiana

Cosponsors (1)
Richard Blumenthal (Democratic)

Finance Committee

Health

Related Bills

  • HR 119-3006: To amend title XVIII of the Social Security Act to limit the coinsurance amount for certain services furnished in an ambulatory surgical center.
  • Introduced
  • In Committee
  • On Floor
  • Passed Chamber
  • Enacted