Medicare’s 2027 Outpatient Rule: Seniors Getting Certain Hospital Drugs Could Save About $900, CMS Says

People with Original Medicare who get certain drugs at hospital outpatient departments could pay about $900 less on average in 2027, under a final rule the Centers for Medicare & Medicaid Services (CMS) issued Nov. 4. The rule also lowers what some patients pay for X-rays, scans and MRIs at hospital-owned clinics and adds more surgeries that can be done without a hospital admission.

The changes take effect Jan. 1, 2027, and are part of the annual update to Medicare’s Hospital Outpatient Prospective Payment System and ambulatory surgical center payment rules, which CMS says affect about 3,500 hospitals and 6,400 surgery centers, according to the agency’s fact sheet.

Why would some seniors pay less for hospital drugs?

The biggest change for patients involves drugs that hospitals buy at a discount through the federal 340B Drug Pricing Program. Under Part B, people with Original Medicare generally pay 20% of the Medicare-approved amount after meeting the Part B deductible. When Medicare pays a hospital more for a drug, the patient’s 20% share rises with it.

A CMS survey of hospital drug costs, conducted from January through April 2026, found that hospitals buy 340B drugs at prices well below the drug’s Average Sales Price. In some cases, CMS said, the patient’s 20% coinsurance alone was more than the hospital paid for the drug.

For 2027, Medicare will pay for 340B-acquired drugs at the Average Sales Price minus 28%, instead of the current Average Sales Price plus 6%. CMS estimates this will lower beneficiaries’ drug costs by about $1.1 billion in 2027 and reduce Original Medicare drug spending by about $4.35 billion. A beneficiary who receives a qualifying drug in a hospital outpatient department is expected to save an average of $900 in 2027, CMS said.

What changes for X-rays, CT scans and MRIs?

Medicare patients can pay different amounts for the same imaging test depending on where they get it. Starting in 2027, Medicare will pay the lower physician-office rate for imaging without contrast, including certain bone density scans, X-rays, ultrasounds, CT scans and MRIs, when performed at certain off-campus hospital outpatient departments. Rural sole community hospitals are exempt.

CMS estimates this will reduce beneficiaries’ cost-sharing by about $70 million and their premiums by about $70 million in the first year. Together with Medicare’s own savings, the agency estimates the change at about $260 million in 2027 and more than $9 billion from 2027 through 2036.

Will more surgeries be available as outpatient procedures?

Yes. CMS is in the second year of a three-year phase-out of the “Inpatient Only” list, which names procedures Medicare pays for only when a patient is admitted to the hospital. For 2027 the agency is removing 637 more services from the list, covering areas such as digestive, urinary, respiratory and endocrine procedures. CMS also is adding several hundred procedures to the list that surgery centers can perform.

That means a doctor can choose an outpatient setting when it is clinically appropriate. CMS says the expanded options will often lower patients’ cost-sharing, though the right setting for any procedure is a medical decision for the patient and doctor.

What are hospitals saying?

Safety-net hospitals strongly oppose the 340B payment cut. America’s Essential Hospitals, which represents more than 400 hospitals, called it “an existential threat to essential hospitals and the patients they serve” and urged Congress to preserve the program, in a statement. Hospitals say they use 340B savings to support care for low-income and uninsured patients. Because the law requires the change to be budget neutral, CMS is raising payments for non-drug hospital outpatient services to offset the drug cuts. The rule also raises overall outpatient payment rates by 2.3% for 2027.

What should people with Medicare do now?

• Know your coverage: CMS’s savings estimates are for people with Original Medicare. Medicare Advantage plans set their own cost-sharing, so check your plan’s Evidence of Coverage.
• If you have a Medigap or other supplemental policy that pays your Part B coinsurance, you may see less of the savings directly.
• Before a scheduled test or procedure, ask whether it can be done in a doctor’s office, an ambulatory surgical center or an off-campus clinic, and compare costs with Medicare’s Procedure Price Lookup tool.
• Review what Part B covers for outpatient hospital services and call 1-800-MEDICARE with billing questions.
• Open enrollment runs through Dec. 7, the last chance to change Medicare Advantage or drug plans for 2027.

HNC previously covered the companion 2027 physician fee schedule final rule.

Key Takeaways

• CMS’s 2027 outpatient final rule, issued Nov. 4, takes effect Jan. 1, 2027.
• Medicare will pay hospitals less for 340B-discounted drugs, which CMS says will save the average affected Original Medicare patient about $900 in 2027.
• Imaging without contrast at certain off-campus hospital clinics will be paid at the lower physician-office rate.
• 637 more procedures come off the “Inpatient Only” list, and surgery centers can do several hundred more.
• Safety-net hospital groups warn the 340B cut threatens their finances.

Frequently Asked Questions

Sources: CMS press release and fact sheet on the CY 2027 OPPS/ASC final rule (CMS-1850-F), Nov. 4, 2026; Federal Register public inspection copy; America’s Essential Hospitals statement; Medicare.gov.

Photo: A clinician adjusts an IV line during an infusion. Linda Bartlett, National Cancer Institute, public domain, via Wikimedia Commons.