Medicare, Medicaid to cover 3 primary care visits free annually
H.R. 1096 — HOPE and Mental Wellbeing Act of 2025 · Filed by Andrea Salinas (D-OR) · 8 cosponsors · Introduced Feb 6, 2025 · Referred to committee
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What it does
This bill requires Medicare and Medicaid to cover the first 3 primary care visits each year without any cost-sharing (copayments, coinsurance, or deductibles) starting in 2026. Primary care visits include mental health services, routine medical care, and care coordination. The bill applies to both traditional Medicare and Medicare Advantage plans, and to Medicaid beneficiaries.
Why we flagged it
The bill's operative mechanism is straightforward: it removes cost barriers to primary care visits in Medicare and Medicaid. The title accurately reflects the substance—expanding access to mental and behavioral health services alongside routine primary care.
What the text implies
- The definition of 'primary care visit' is broad and includes mental/behavioral health services, care coordination, and nonspecialty medical services—potentially capturing services beyond traditional primary care, which may create ambiguity in claims processing and provider billing.
- No explicit funding mechanism or appropriation is stated in the text; the bill does not specify how Medicare/Medicaid will absorb the cost of eliminating cost-sharing for these visits, raising questions about whether this is a mandate without dedicated funding.
The full analysis lists 4 implications of this text.
Who stands to gain
Medicare beneficiaries (reduced out-of-pocket costs); Medicaid beneficiaries (reduced out-of-pocket costs); Primary care providers and mental health service providers (increased volume of covered visits)