Costs & IRMAA
Same scan, same drug, a smaller bill in 2027?
A new Medicare proposal would stop paying more for an X-ray or MRI just because it happens in a hospital-owned clinic, and would pass hospital drug discounts through to patients.
By the Goodsurance editorial teamJuly 3, 2026
On July 2, 2026, Medicare proposed its payment rules for hospital outpatient care in 2027, and two pieces of it aim directly at what patients pay. The first is about where care happens. Today, Medicare can pay more for the same imaging test, an X-ray or an MRI, when it is done in a clinic a hospital owns than when it is done in an independent doctor's office, and the patient's share rises with it. CMS says that gap also nudges hospitals to buy up independent practices, because the same service earns more under a hospital's name. The proposal would pay the physician-office rate for basic imaging without contrast at certain off-campus hospital-owned clinics. CMS estimates that change would lower Medicare Part B spending by about $260 million in its first year, including roughly $70 million less in beneficiary cost sharing and about $70 million in reduced premiums. Rural sole community hospitals would be exempt. The second piece is about drugs given in hospital outpatient settings. Many hospitals buy drugs at steep discounts through a federal program called 340B, but Medicare has been paying them well above those acquisition costs. A CMS survey run earlier this year found the gap was sometimes so wide that a patient's 20 percent coinsurance was more than the hospital had paid for the entire drug. The proposal would cut Medicare's payment for those drugs to average sales price minus 33.4 percent, which CMS estimates would save people with Original Medicare about $1.15 billion in drug costs in 2027, with about $4.55 billion more in taxpayer savings. By law the change is budget neutral, so payments for non-drug services would rise by an equal amount. The rule also keeps phasing out the inpatient-only list, proposing to let 638 more services be done in outpatient settings when a doctor judges it safe and appropriate, which can mean a shorter stay and, for some services, lower out-of-pocket costs. All of this is a proposal, open for public comment for 60 days, and hospitals have fought hard against both site-neutral payment and 340B cuts before, so the final version may look different. For now, the useful habit costs nothing: when a test or an infusion is scheduled, it is fair to ask whether the location is hospital-owned and whether the same service is available somewhere that bills less.
The same scan can cost you more because of who owns the building. Medicare wants to change that.
In plain words
Medicare wants to change how it pays for some care outside the hospital. Right now, the same X-ray or MRI can cost you more if it is done at a clinic a hospital owns, instead of a regular doctor's office. A new plan from Medicare, shared on July 2, 2026, would pay the same rate for basic scans in both places. Medicare says that would save patients about $70 million in cost sharing in the first year. There is a second part. Hospitals often buy drugs at big discounts through a program called 340B. But Medicare kept paying full price, and patients paid their share of that full price. Sometimes a patient's 20 percent share cost more than the hospital paid for the whole drug. The new plan would cut those payments to match real costs. Medicare says that would save patients about $1.15 billion on drugs in 2027. None of this is final yet. It is a proposal, and people can comment on it for 60 days. In the meantime, one simple habit helps: when you schedule a scan or an infusion, ask if the place is owned by a hospital, and ask if the same service costs less somewhere else.
Understand the basics first
Source: Centers for Medicare and Medicaid Services
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