WASHINGTON, D.C. - Last week, Representative Rob Menendez (D-NJ) joined Reps. John Larson (D-CT), Mike Kelly (R-PA), and Troy Balderson (R-OH) in introducing the Medicare Beneficiary Co-Pay Fairness Act of 2025, which lowers out-of-pocket healthcare costs for Medicare beneficiaries by capping co-pays for those seeking care at ambulatory surgical centers (“ASCs”). “Our healthcare system should reward value and efficiency, not penalize patients based on where they receive care,” said Congressman Menendez. “With this legislation, we’re ensuring fairness by lowering out-of-pocket costs and reinforcing the principle that Medicare should always work for patients.” “I am proud to introduce this bill with my colleagues on both sides of the aisle to make surgical care more affordable and accessible for our seniors,” said Congressman Larson. “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 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,” said Congressman Kelly. “Extending co-pay caps improves efficiency and provides fairer costs for patients,” said Rep. Balderson. “This ensures patients are able to receive necessary and preventative services in lower-cost health care settings.” The bill focuses on creating greater parity in the healthcare system by lowering the cost of care provided at ASCs, which are specialized healthcare facilities that provide surgical and diagnostic procedures without requiring patients to be admitted to the hospital or stay overnight. While they are similar in nature to Hospital Outpatient Departments (“HOPD”), patients that receive care at ASCs are required to pay more for the same procedures than those who go to HOPDs, because only HOPD patients currently benefit from a copay cap. This reduces equitable access to care and causes patients who utilize the over 6,300 Medicare-certified ASCs nationwide — including seven in New Jersey’s Eighth Congressional District — to face potentially higher out-of-pocket expenses. The Medicare Beneficiary Co-Pay Fairness Act seeks to rectify this by extending the existing co-pay cap to ASCs, ensuring fairer costs for patients and supporting the continued growth and utilization of efficient, lower-cost surgical settings. For full bill text, click here.
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