Medicare has an unfair copay system for ASCs. For higher-cost surgeries, patients face much higher copays in ASCs compared to hospital outpatient departments (HOPD) for the same procedures. Medicare beneficiaries who receive treatment in either an ASC or an HOPD are typically responsible for 20 percent of their cost of care. In HOPDs, this 20 percent copay is capped at the hospital inpatient deductible amount, which is $1,676 for 2025. In ASCs, there is no copay cap. As a result, Medicare patients treated in an ASC face higher copays for approximately 150 procedures. This discourages patients from using the potentially more cost-effective ASC setting and creates unequal access to care for those without supplemental insurance.