Kelly, Menendez, Balderson, Larson introduce Medicare Beneficiary Co-Pay Fairness Act of 2025

WASHINGTON, D.C. -- On Thursday, April 24, U.S. Representatives Mike Kelly (R-PA), a member of the Ways & Means Subcommittee on Health, Robert Menendez, Jr. (D-NJ), Troy Balderson (R-OH), and John Larson (D-CT) introduced the Medicare Beneficiary Co-Pay Fairness Act of 2025. The Medicare Beneficiary Co-Pay Fairness Act of 2025 aims to address the current inequity in Medicare's co-pay structure to help lower costs for patients seeking care at ambulatory surgical centers (ASCs).

"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 Rep. Kelly.

"Our healthcare system should reward value and efficiency, not penalize patients based on where they receive care," said Congressman Menendez. "With the legislation, we’re ensuring fairness, lowering out-of-pocket costs, and reinforcing the principle that Medicare should always work for patients."

"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.”

“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 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.”

BACKGROUND

Currently, while patients in both ASCs and Hospital Outpatient Departments (HOPDs) typically face a 20% co-pay, only HOPDs benefit from a co-pay cap, set at $1,676 for 2025. This leaves Medicare patients utilizing the over 6,300 Medicare-certified ASCs nationwide with potentially higher out-of-pocket expenses for approximately 150 procedures, even though ASCs offer high-quality, cost-effective care projected to save Medicare billions.

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.

You can read the full bill text here.