Medicare Advantage Plans - Ambulatory Surgery Centers

About two-thirds of all hospitals and health systems intend to increase their investments in Ambulatory Surgery Centers (ASCs), according to the third annual national survey of senior executives and clinical leaders at health systems and hospitals. The survey results highlight the growing importance of ASCs to hospitals, which is further magnified by the increasing and ongoing shift of elective cases in the COVID-19 era.1

"ASCs continue to be the model for providing high-quality, low-cost surgical care, and many hospitals are converting their outpatient departments or migrating cases to ASCs," said Joan Dentler, president and CEO of Avanza. "This was true before the pandemic reinforced the business case for every hospital having at least one freestanding ASC in its portfolio.”1

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So why is this important and how does it relate to many Medicare Advantage plans?

Many MAPD plans (Medicare Advantage with Prescription Drug coverage included) have a significantly higher copayment for services received at a hospital owned Ambulatory Surgery Center versus a non-hospital affiliated stand alone Ambulatory Surgery Center, even if both are in-network. A lot of these new Hospital Owned Ambulatory Surgery Centers are not physically located in a hospital setting. Therefore Medicare Advantage plan members may get confused and incorrectly believe that they are only responsible for the lower copay of a non-hospital affiliated stand alone Ambulatory Surgery Center benefit. So it is important to ask in advance if the Ambulatory Surgery Center you plan to go to is a non-hospital affiliated stand alone Ambulatory Surgery Center or you may be responsible for paying a more expensive copay than you thought.

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