New Medicare rules could lower costs for certain hospital-administered drugs, imaging tests, and outpatient procedures. But the savings depend on what care you receive, where you receive it, and which Medicare coverage you have.
Imagine two Medicare patients who need the same imaging test.
One schedules the scan at a hospital-affiliated outpatient center. The other visits an independent medical facility.
Even if the medical service is similar, their bills may be different.
That’s one of the problems the Centers for Medicare & Medicaid Services (CMS) is addressing in its newly finalized Medicare outpatient payment rules for 2027.
Announced on November 4, 2026, the changes include lower payments for certain hospital-administered drugs, new payment rules for imaging services, and expanded options for outpatient surgery.
CMS estimates that these policies will reduce some beneficiaries’ out-of-pocket costs.
But there’s an important distinction:
A national savings estimate doesn’t tell you how much your own Medicare bill will change.
Here’s what the new rules mean and how to check whether they could affect your costs.
What Is Changing for Medicare Outpatient Care in 2027?
The new rules affect Medicare payments for services provided in hospital outpatient departments and ambulatory surgical centers.
These are places where patients receive medical care without being formally admitted to a hospital as inpatients.
Outpatient care may include diagnostic imaging, certain medications, same-day procedures, and surgery.
According to the CMS 2027 outpatient final rule, three changes deserve particular attention.
| 2027 change | What it means | Who may benefit |
|---|---|---|
| Lower payments for certain 340B drugs | Medicare payments more closely reflect discounted hospital drug acquisition costs | Eligible Original Medicare patients receiving qualifying outpatient drugs |
| New payment rates for certain imaging tests | Some off-campus hospital departments will receive lower payment rates for non-contrast imaging | Patients receiving affected scans at eligible locations |
| More outpatient surgery options | Additional procedures may be performed in eligible outpatient settings | Patients whose care can safely and appropriately be provided in those settings |
These are Medicare payment-policy changes, not a promise that every Medicare bill will decrease.
Let’s look at the details.
1. Certain Hospital-Administered Drugs Could Cost Less
One of the largest changes involves the federal 340B Drug Pricing Program.
Under this program, eligible hospitals and other participating health care organizations can purchase certain medications at discounted prices.
For years, Medicare payment amounts for some of these drugs have differed substantially from what hospitals actually paid to acquire them.
CMS says its hospital drug acquisition-cost survey found significant differences between discounted 340B acquisition costs and acquisition costs outside the program.
In some cases, the amount patients paid in cost-sharing was greater than the hospital’s acquisition cost for the medication.
What changes in 2027?
Beginning in 2027, CMS will generally pay for affected 340B-acquired outpatient drugs at the drug’s Average Sales Price (ASP) minus 28%, subject to the policy’s applicable exceptions.
Because Original Medicare cost-sharing for many Part B outpatient drugs is tied to Medicare-approved payment amounts, lowering those amounts can also reduce what eligible patients pay.
CMS estimates that the policy will:
- Reduce Original Medicare beneficiary payments for affected drugs by approximately $1.1 billion in 2027.
- Reduce Medicare program drug payments by approximately $4.35 billion.
- Produce an average estimated $900 drug-cost saving for beneficiaries receiving qualifying drugs in hospital outpatient departments.
That last figure needs some explanation.
Does this mean you’ll save $900?
Not necessarily.
The $900 is CMS’s estimated average saving for beneficiaries who receive qualifying drugs under the affected outpatient payment policy.
It is not a payment, refund, or automatic discount available to everyone enrolled in Medicare.
If you don’t receive an affected drug, this particular policy may not change your medical bills.
Your actual savings also depend on the treatment, the hospital’s participation and billing circumstances, your insurance coverage, and the services you receive.
Also, the rule requires the drug-payment reduction to be implemented in a budget-neutral way, with corresponding increases in certain non-drug outpatient payments. That makes it especially important not to assume that every outpatient service will cost less.
SavingQueen tip: If you receive an infusion, injection, or another costly drug at a hospital outpatient department, ask the billing office whether your treatment is affected by the 2027 Medicare 340B payment changes.
This is primarily about qualifying hospital outpatient drug payments—not a general reduction in pharmacy prescription prices or a new Medicare Part D discount.
2. Certain Imaging Tests Could Have Lower Copayments
Have you ever wondered why an imaging test at a hospital-affiliated facility might cost more than a similar service at an independent medical office?
Part of the difference can come from how Medicare pays the facility.
Hospital outpatient departments and independent physician offices may operate under different Medicare payment systems.
CMS is expanding a policy intended to reduce some of those differences.
Which imaging services are affected?
The 2027 rule applies to certain imaging services performed without contrast material at specified off-campus hospital outpatient departments.
Examples of affected types of services may include:
- Bone density scans
- X-rays
- Ultrasounds
- CT scans without contrast
- MRI scans without contrast
Not every scan in these categories qualifies. The precise billing code and facility designation matter.
And the policy does not automatically extend to every hospital, every imaging center, or scans performed with contrast.
CMS also excludes rural Sole Community Hospitals from this particular payment adjustment.
How much could patients save?
CMS estimates that the imaging payment change will reduce Medicare Part B expenditures by approximately $260 million in its first year.
Within its estimates, the agency projects approximately $70 million in reduced beneficiary cost-sharing obligations, as well as a separate estimated reduction in beneficiary premium costs.
These are national estimates, not per-patient savings amounts.
For an individual patient, the difference could be modest, substantial, or nonexistent depending on the procedure and location.
What should you check before scheduling?
Before an imaging appointment, ask the facility:
“Will this test be billed as a hospital outpatient service or as an independent physician-office service?”
Then ask whether the facility can estimate your Medicare out-of-pocket cost.
This is particularly worthwhile when you have a choice of medically appropriate locations.
However, don’t change or delay a medically necessary test solely because one facility advertises a lower price. Confirm with your treating professional that the alternative location can provide the care you need.
3. Medicare Is Expanding Outpatient Surgery Options
The third change concerns where certain procedures may be performed.
CMS is continuing to remove procedures from its Medicare Inpatient Only list and expand the list of procedures eligible for payment at ambulatory surgical centers.
An ambulatory surgical center (ASC) is a facility that provides qualifying surgical services without requiring a traditional inpatient hospital admission.
For appropriate patients and procedures, an outpatient setting may offer convenience and different cost-sharing arrangements.
Does outpatient surgery automatically cost less?
No.
The total cost depends on the procedure, the facility, professional fees, required services, insurance coverage, and the patient’s clinical needs.
For example, some procedures may be appropriately performed in either a hospital outpatient department or an ambulatory surgical center.
But other patients may require hospital-based resources or monitoring.
The correct setting is a medical decision—not just a price comparison.
If your doctor recommends a procedure that may be performed in more than one setting, ask whether the available choices are medically appropriate for you.
Then compare the expected out-of-pocket costs.
For Original Medicare beneficiaries, Medicare’s Procedure Price Lookup can help compare national average costs for certain outpatient procedures at hospital outpatient departments and ambulatory surgical centers.
The estimates are not personalized quotes, and 2026 values should not be mistaken for confirmed 2027 prices.
Original Medicare vs. Medicare Advantage: Why Your Coverage Matters
This is perhaps the most important distinction for readers trying to estimate their own savings.
The 2027 rule changes Medicare payment systems, but that does not mean every Medicare beneficiary’s out-of-pocket expenses change in the same way.
If you have Original Medicare
Original Medicare includes Part A and Part B.
Part B generally covers many outpatient medical services.
After meeting the applicable Part B deductible, beneficiaries typically pay 20% of the Medicare-approved amount for covered doctor and other provider services. Hospital outpatient services may also involve facility copayments, and exceptions apply.
The amount you owe can depend on the service, location, and supplemental coverage.
A Medicare Supplement Insurance (Medigap) policy may pay some of your cost-sharing.
If you have Medicare Advantage
Medicare Advantage plans are offered by private insurers approved by Medicare.
These plans must cover medically necessary services covered under Original Medicare, subject to applicable plan rules, but their copayments, coinsurance, networks, and authorization requirements can differ.
Therefore, a CMS estimate of Original Medicare savings does not automatically translate into the same savings for your Medicare Advantage plan.
Review your plan’s 2027 Evidence of Coverage, benefit documents, and provider network.
If you’re considering a scan or procedure, ask your plan for the expected member responsibility at the specific location.
The practical lesson is straightforward:
Check your own coverage before assuming a national Medicare payment change will appear directly on your bill.
For additional background, see Medicare’s official outpatient hospital coverage explanation.
A Simple Example: Why the Location of Care Matters
Consider this hypothetical example.
A patient needs an outpatient procedure. Both a hospital outpatient department and an ambulatory surgical center are medically appropriate options.
The patient obtains the following illustrative estimates:
| Hospital outpatient department | Ambulatory surgical center | |
|---|---|---|
| Estimated Medicare-approved amount | $2,000 | $1,500 |
| Illustrative patient share at 20% | $400 | $300 |
In this simplified comparison, the patient share differs by $100.
These numbers are hypothetical, not a forecast of the 2027 rule’s effect on any particular procedure.
Actual Medicare outpatient billing may include separate facility and professional components, deductible effects, service-specific copayment rules, and supplemental coverage.
The point is not that one type of facility is always cheaper.
It’s that the setting can change the cost, and comparing an estimate before treatment can help avoid surprises.
Five Questions to Ask Before Your Next Outpatient Appointment
You don’t need to study the full CMS regulation to make use of this information.
Start with five questions.
1. Is this service covered under my Medicare arrangement?
Confirm whether the treatment is covered by Original Medicare or your Medicare Advantage plan, including any conditions.
2. Where will the service be billed?
Ask whether you’re receiving care at a hospital outpatient department, an independent physician office, or an ambulatory surgical center.
The facility’s billing status matters.
3. Will any 2027 payment changes affect this service?
If you’re receiving a hospital-administered medication or non-contrast imaging, ask whether the new payment policy applies to the specific billing codes and facility.
4. What is my estimated out-of-pocket cost?
Request an estimate that includes applicable facility charges, professional fees, deductible amounts, and patient cost-sharing.
If you have Medicare Advantage or Medigap, confirm how your coverage affects the estimate.
5. Can I receive the service safely at another location?
If more than one medically appropriate facility is available, ask your treating professional about the alternatives.
Compare the actual expected patient cost—not just the advertised price.
The SavingQueen Medicare Outpatient Cost Checklist
Before scheduling a qualifying outpatient service in 2027:
- Confirm whether you have Original Medicare or Medicare Advantage.
- Ask for the exact procedure or drug billing code.
- Verify the facility type and how the service will be billed.
- Ask whether the new 340B or non-contrast imaging payment policy applies.
- Request an estimated out-of-pocket cost.
- Check Medigap benefits or Medicare Advantage network and authorization requirements.
- Save the estimate and compare it with your Medicare Summary Notice or plan Explanation of Benefits after the claim is processed.
If the bill doesn’t match what you expected, request an itemized explanation from the provider and contact Medicare or your plan for help understanding the claim.
Bottom Line: Lower Medicare Payments Don’t Mean Everyone Gets the Same Savings
The 2027 Medicare outpatient final rule includes meaningful changes that may reduce costs for some beneficiaries.
Certain hospital-administered drugs may have lower beneficiary cost-sharing. Some imaging tests performed at affected off-campus hospital facilities may also cost less. Expanded outpatient surgery options may give eligible patients additional choices.
But the savings are not universal.
They depend on the exact service, facility, coverage, and patient circumstances.
The most useful thing you can do is ask what your particular service will cost before receiving it.
A short conversation with the provider’s billing department—and your Medicare plan, when applicable—may tell you more about your expected expenses than a national savings estimate ever could.
Information verified November 5, 2026. This article provides general Medicare and consumer financial information, not individualized medical, insurance, or financial advice. Do not change or postpone medically necessary care solely to reduce costs.
Official Sources
- CMS — Calendar Year 2027 Hospital Outpatient and Ambulatory Surgical Center Final Rule, November 4, 2026
- CMS — Medicare Outpatient Final Rule Expands Surgical Options and Lowers Selected Costs
- Medicare.gov — Outpatient Hospital Services
- Medicare.gov — Medicare Costs
- Medicare.gov — Procedure Price Lookup
