S. 1776

1. Short title
2. Limitation on coinsurance amount

1. Short title

This Act may be cited as the "Medicare Beneficiary Co-Pay Fairness Act".

2. Limitation on coinsurance amount

(a) In general - Section 1833 of the Social Security Act (42 U.S.C. 1395l) is amended—

(1) - in subsection (a)(1)(G), by inserting "subject to subsection (ee)," before "with respect to facility services"; and

(2) Limitation on coinsurance amount for certain services furnished in an ambulatory surgical center - by adding at the end the following new subsection:

(ee) Limitation on coinsurance amount for certain services furnished in an ambulatory surgical center - In the case that application of subsection (a)(1)(G) would result in the imposition of a coinsurance amount with respect to facility services described in such subsection furnished during a year with respect to a surgical procedure that exceeds the amount of the inpatient hospital deductible established under section 1813(b) for such year, the Secretary shall—

(1) - reduce the amount of such coinsurance to an amount equal to such deductible; and

(2) - pay to the supplier furnishing such services an amount equal to such reduction.

(b) Effective date - The amendments made by this section shall apply to services furnished on or after January 1, 2026.

119-S1776

Medicare Beneficiary Co-Pay Fairness Act

119th CONGRESS

1st Session

S. 1776

1. Short title

2. Limitation on coinsurance amount