U.S. Representatives Mike Kelly, Robert Menendez, Jr., Troy Balderson, and John Larson have introduced the Medicare Beneficiary Co-Pay Fairness Act of 2025. This legislative initiative is intended to address the disparity in Medicare’s co-pay structure and aims to reduce costs for patients at ambulatory surgical centers (ASCs).
Representative Mike Kelly remarked, “The Medicare Beneficiary Co-Pay Fairness Act takes a major step toward lowering patient costs. This legislation saves taxpayer money by streamlining the payment process. I thank my colleagues for joining me in this effort.”
Congressman Robert Menendez emphasized the bill’s focus on fairness in the healthcare system, saying, “With the legislation, we’re ensuring fairness, lowering out-of-pocket costs, and reinforcing the principle that Medicare should always work for patients.”
Representative Troy Balderson highlighted the benefits of co-pay caps, noting, “Extending co-pay caps improves efficiency and provides fairer costs for patients. This ensures patients are able to receive necessary and preventative services in lower-cost health care settings.”
Representative John Larson expressed pride in the bipartisan effort to make surgical care more affordable for seniors. He stated, “Connecticut’s 61 Ambulatory Surgical Centers provide preventive services and essential procedures to thousands of patients annually, including cataract surgeries and orthopedic care. 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 background of the issue highlights that while patients at both ASCs and Hospital Outpatient Departments (HOPDs) often encounter a 20% co-pay, only HOPDs currently enjoy a co-pay cap, set at $1,676 for 2025. This leaves Medicare patients using the more than 6,300 Medicare-certified ASCs nationwide facing potentially higher out-of-pocket costs for about 150 procedures, despite ASCs offering cost-effective care expected to save Medicare billions.
The proposed act seeks to extend the existing co-pay cap to ASCs, promoting equitable costs for patients and supporting the growth of efficient, cost-effective surgical settings.
