A bipartisan group of U.S. representatives recently introduced the Medicare Beneficiary Co-Pay Fairness Act of 2025, a bill that aims to address inequities in Medicare’s copay structure and help lower costs for patients receiving care at ambulatory surgery centers (ASCs).
Currently, patients who seek care at both ASCs and hospital outpatient departments (HOPDs) typically face a 20% co-pay. However, while HOPDs benefit from a copay cap, set at $1,676 for 2025, patients at ASCs often face higher out-of-pocket costs for the same procedures.
This inequity impacts over 6,300 Medicare-certified ASCs nationwide, with patients potentially paying more for around 150 different procedures, despite ASCs offering high-quality and cost-effective care, the bill’s supporters argue.
The bill was introduced by Rep. Mike Kelly (R-Pa.), a member of the Ways & Means Subcommittee on Health, alongside Rep. Robert Menendez, Jr. (D-N.J.), Rep. Troy Balderson (R-Ohio), and Rep. John Larson (D-Conn.).
“The Medicare Beneficiary Co-Pay Fairness Act takes a major step toward lowering patient costs,” Rep. Kelly said in a press release. “This legislation saves taxpayer money by streamlining the payment process,”
“Our health care system should reward value and efficiency, not penalize patients based on where they receive care,” Congressman Menendez said.
The legislation seeks to extend the existing co-pay cap to ASCs, ensuring fairer costs for patients and supporting the growth of outpatient facilities.
“Extending co-pay caps improves efficiency and provides fairer costs for patients,” Rep. Balderson said. “This ensures patients are able to receive necessary and preventative services in lower-cost health care settings.”
Rep. Larson said that there could be widespread benefits of the bill for both patients and health care providers.
“Connecticut’s 61 ambulatory surgical centers provide preventive services and essential procedures to thousands of patients annually, including cataract surgeries and orthopedic care,” he said. “The Medicare Beneficiary Co-Pay Fairness Act will ensure patients no longer have to pay more for a procedure simply because they went to an outpatient provider.”
The bill could also reduce health care costs for seniors by leveling the playing field between ASCs and HOPDs, especially for patients in the Medicare system.
“With the legislation, we’re ensuring fairness, lowering out-of-pocket costs, and reinforcing the principle that Medicare should always work for patients,” Menendez said.
The Ambulatory Surgery Center Association (ASCA) is among the groups that support the bill.
“The sponsors of the Medicare Beneficiary Copay Fairness Act are to be commended for this effort to level the playing field with regard to Medicare beneficiary out-of-pocket costs when receiving outpatient surgery,” ASCA CEO Bill Prentice said in a statement. “Enactment of this bill will reduce costs for both patients and the Medicare program.”
