US Federal Senate Bill SB1776

US Federal 2025-2026 Regular Session

• Introduced: 5/15/25
• Refer: 5/15/25

Caption

Medicare Beneficiary Co-Pay Fairness Act

Summary

SB 1776, titled the Medicare Beneficiary Co-Pay Fairness Act, would amend the Social Security Act to cap Medicare coinsurance for certain ambulatory surgical center facility services. Under current law, some beneficiaries can face coinsurance amounts that exceed the annual inpatient hospital deductible for the same year; this bill would require the Secretary of Health and Human Services to reduce any such coinsurance to no more than that deductible level. The bill also directs Medicare to make a corresponding payment to the supplier furnishing the services for the amount reduced, so providers are made whole for the capped beneficiary cost-sharing. The cap would apply only to services furnished on or after January 1, 2026. In practical terms, the bill is aimed at limiting out-of-pocket costs for Medicare beneficiaries receiving qualifying outpatient surgical procedures in ambulatory surgical centers, while preserving provider reimbursement through Medicare payment adjustments. It does not broadly rewrite Medicare cost-sharing rules, but instead creates a targeted limitation for a specific category of facility services.

Impact

The bill would amend section 1833 of the Social Security Act, changing Medicare Part B cost-sharing rules for certain ambulatory surgical center facility services. It would require the Secretary to reduce beneficiary coinsurance when it would otherwise exceed the inpatient hospital deductible and to pay the provider the difference, affecting Medicare beneficiaries, ambulatory surgical centers, and Medicare reimbursement administration beginning in 2026.

Sentiment

The available context suggests generally favorable or bipartisan support for the bill’s consumer-protection goal, as reflected by its bipartisan sponsorship from Senators Cassidy and Blumenthal. No committee transcript or vote record is available, so there is no evidence of formal opposition in the materials provided. The bill’s framing as a fairness measure indicates an intent to reduce unexpected or excessive beneficiary cost-sharing.

Contention

The main policy issue is how to balance lower out-of-pocket costs for Medicare beneficiaries against Medicare program spending and administrative complexity. Potential concerns could include whether capping coinsurance for ambulatory surgical center services creates uneven treatment compared with other Medicare-covered services, and how the reimbursement offset to suppliers would be implemented. No specific objections are recorded in the provided materials, but any contention would likely center on cost, payment policy, and the scope of beneficiary relief.