Image by oljamu from PixabayAmbulatory surgery center (ASC) leaders are rallying behind new bipartisan legislation that aims to eliminate a cost disparity that advocates of the bill say is driving up expenses for seniors and steering them away from lower-cost surgical settings.
If enacted, the Medicare Beneficiary Co-Pay Fairness Act of 2025 would cap Medicare co-payments for procedures performed in ASCs at the same level already applied to hospital outpatient departments (HOPDs). The bill was introduced in the U.S. Senate on May 15 and in the House in April.
In the Senate, the legislation is backed by Sens. Richard Blumenthal (D-Conn.) and Bill Cassidy (R-La.).
“If your grandmother depended on Medicare for life-saving treatment, you would not want to hear that Medicare was cutting corners,” said Cassidy, who has a background as a physician, said in a statement. “This bill makes costs fairer for patients while keeping the quality of care high.”
Under the current policy, Medicare patients who receive care at either an ASC or HOPD are generally responsible for 20% of the procedure’s cost.
However, in HOPDs, that 20% is capped at the hospital inpatient deductible, which was $1,676 in 2025, while no such cap exists for ASCs.
As a result, patients often pay more out-of-pocket when choosing an ASC for certain procedures, even though ASCs are reimbursed at significantly lower rates than HOPDs, Bill Prentice, CEO of the Ambulatory Surgery Center Association (ASCA), said in a press release.
“The current absence of a limit on Medicare beneficiary out-of-pocket costs in ASCs, despite one being in place for procedures performed in hospitals, unintentionally drives patients to higher-cost care settings,” Prentice said.
“The Medicare Beneficiary Co-Pay Fairness Act of 2025 will allow beneficiaries to receive care in the ASC setting without paying more for the procedure,” he added.
ASCA Director of Government Relations Stephen Abresch detailed the scope of the bill and what it seeks to address during a recent podcast hosted by the industry group.
“ ,… In HOPDs, that 20% is capped,” Abresch said. “When Medicare beneficiaries seek care in an ASC, that 20% isn’t, so their out-of-pocket costs can exceed that in certain cases, making care look more expensive in our setting.”
Currently, around 183 procedures are impacted by this cost disparity, according to ASCA.
That number is expected to grow as more complex and device-intensive surgeries are added to the ASC-covered procedure list. This financial disincentive creates an “artificial barrier” to accessing care in ASCs, even though the setting often saves Medicare money, Abresch said.
“When the patient chooses an HOPD instead of an ASC due to higher co-pays, it ultimately costs Medicare more,” he said.
According to a 2020 analysis from KNG Health Consulting, ASCs are projected to reduce Medicare program costs by $73.4 billion between 2019 and 2028.
To support the bill’s passage, ASCA is encouraging its members to engage in grassroots advocacy.
“We’ll launch our letter-writing campaign, … giving our membership a way to directly speak to their members of Congress and senators,” Abresch said. “We’re not trying to take anything away from anyone with this legislation; we are simply trying to level the playing field for our setting and for Medicare beneficiaries.”
With bipartisan support and growing advocacy from the ASC community, ASCA leaders believe the Medicare Beneficiary Co-Pay Fairness Act has a real chance to change how seniors access outpatient surgical care.
Still, it won’t be easy.
“Getting anything through Congress is still a heavy lift,” ASCA Public Affairs Director Charlie Leonard said on the podcast.
