Medicare 2026

Hospital Outpatient Coinsurance in 2027: What the 340B Drug and Off-Campus Imaging Changes Mean for You

Starting January 1, 2027, two changes in Medicare's hospital outpatient payment rules could lower what many people with Medicare pay at the hospital — especially for certain drugs given in outpatient settings and for imaging done at some hospital-owned clinics located away from the main hospital campus. The changes come from CMS's calendar year 2027 hospital outpatient final rule with comment period (CMS-1850-FC), published in the Federal Register on November 6, 2026 and effective January 1, 2027. Here's a plain-English look at what's changing, who it affects, and what to keep in mind as you plan for the year ahead.

The 340B drug change, explained simply

The 340B Program lets certain hospitals buy outpatient drugs at discounted prices. Under Medicare Part B, patients typically owe a 20 percent copayment based on the hospital outpatient payment rate for Part B drugs — and CMS says that rate has generally been the drug's average sales price plus 6 percent, regardless of what the hospital actually paid under 340B.

For 2027, CMS will pay average sales price minus 28 percent for separately payable drugs and biologicals that hospitals acquire through the 340B Program. Vaccines, drugs with transitional pass-through status, and non-opioid pain management drugs are not included in the reduced payment. Because your coinsurance is calculated from the payment rate, lowering the payment rate lowers what you owe. CMS estimates this will reduce beneficiary copayments for drugs by about $1.1 billion in 2027.

A few hospital types are exempt from the 340B payment policy for 2027 and later: rural sole community hospitals, PPS-exempt cancer hospitals, and children's hospitals. If you receive infusions or injections at one of those exempt facilities, the 340B payment change won't apply to your drugs there.

By law, this change has to be budget-neutral. To offset the reduced drug payments, CMS estimates it will raise hospital outpatient payments for non-drug services by 7.50 percent. That means some non-drug outpatient services may carry slightly higher coinsurance, even as drug coinsurance drops.

The off-campus imaging change, explained simply

Many hospitals operate outpatient clinics in buildings that aren't on the main hospital campus. Some of these "off-campus" departments are "excepted," meaning they've historically been paid under the hospital outpatient system. CMS found that average beneficiary cost sharing for imaging without contrast at excepted off-campus departments was more than twice what people paid for the same service in freestanding physician offices.

For 2027, CMS will pay for imaging without contrast at excepted off-campus hospital outpatient departments at the physician fee schedule equivalent rate — the same benchmark used for imaging in a doctor's office. Rural sole community hospitals are exempt. CMS estimates the imaging change saves $260 million in 2027, with $70 million of that coming to beneficiaries through reduced coinsurance.

If you have Original Medicare without supplemental coverage, your out-of-pocket for a non-contrast scan at an affected off-campus department should drop compared with prior years. If you have Medicare Advantage, your plan sets its own cost-sharing rules, so check your Evidence of Coverage.

How this fits with the rest of your 2027 Medicare picture

Several other national facts are already confirmed for 2027:

• The Part D out-of-pocket cap rises to $2,400 (up from $2,100 in 2026). Once your out-of-pocket spending on covered Part D drugs hits that cap, you pay $0 for covered drugs for the rest of the year.
• The most any Part D plan may charge as a deductible in 2027 is $700.
• The Part D base beneficiary premium for 2027 is $41.33. This is a national figure used to calculate the late-enrollment penalty; actual plan premiums are set plan by plan.
• The Social Security Administration announced on October 14, 2026 a 3.6 percent cost-of-living adjustment for benefits payable beginning January 2027.

The 2027 Part B standard premium and deductible, and the 2027 IRMAA income-related surcharges, had not been announced at the time of this writing. CMS typically announces these figures in the fall. Check Medicare.gov for the official numbers once they are released.

Your enrollment windows

Annual Enrollment runs October 15 – December 7, 2026, with choices taking effect January 1, 2027. This is the main window to join, switch, or drop a Medicare Advantage or Part D plan.

If you have Medicaid or qualify for Extra Help (the Part D Low-Income Subsidy), you have additional flexibility. Since 2025, there's a monthly Special Enrollment Period to move from Medicare Advantage to Original Medicare paired with a stand-alone Part D plan, or to switch stand-alone Part D plans. Full-benefit dual-eligible individuals can also join an integrated Dual Eligible Special Needs Plan (D-SNP) in any month.

Original Medicare plus Medigap vs. Medicare Advantage — a neutral look

Both paths have trade-offs. Original Medicare lets you see any provider nationwide that accepts Medicare, and a Medigap policy can help cover coinsurance and deductibles — including the hospital outpatient coinsurance discussed here — but Medigap carries its own premium and doesn't include drug coverage, so you'd typically add a stand-alone Part D plan. Medicare Advantage bundles hospital, medical, and usually drug coverage with an annual out-of-pocket maximum for in-network medical services, but plans use networks and may require prior authorization. The right fit depends on your doctors, your medications, your budget, and how you prefer to get care.

Where to learn more

For official, current information — including the 2027 Part B figures once released — visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048, available 24 hours a day, 7 days a week.

This article is for general education. It is not affiliated with or endorsed by any government agency.