To amend title XVIII of the Social Security Act to require coverage of 3 primary care visits without cost sharing each year under the Medicare program.
Analysis under review: This bill has generated analysis that may be too generic or incomplete. Clause-level evidence remains available below.
Summary
What This Bill Does
The HOPE and Mental Wellbeing Act requires Medicare and Medicaid to cover the first three primary care visits each year at no cost to patients, starting in 2026. Primary care visits include mental health services, behavioral health services, general medical care, and care coordination. This applies to traditional Medicare, Medicare Advantage plans, and Medicaid.
Who Benefits and How
Medicare and Medicaid beneficiaries benefit by avoiding copayments, deductibles, and coinsurance for their first three primary care appointments each year, reducing out-of-pocket healthcare costs. Primary care physicians, mental health providers, and care coordination services benefit from increased patient access since cost barriers are removed, likely leading to more visits and higher revenue. Patients who previously delayed care due to cost concerns now have a clearer path to preventive and mental health services.
Who Bears the Burden and How
The federal government bears increased costs as Medicare must fully cover these visits without patient cost sharing. State governments face higher Medicaid costs due to the same coverage mandate. Medicare Advantage plans and private insurers participating in Medicare/Medicaid must absorb the cost of these visits and update their systems to comply with the new coverage requirements. Health insurers face additional administrative burdens to implement the changes across their plans.
Key Provisions
- Eliminates all cost sharing (copayments, deductibles, coinsurance) for the first 3 primary care visits per year for Medicare beneficiaries, effective 2026
- Defines primary care visits broadly to include mental health services, behavioral health services, nonspecialty medical care, and care coordination
- Requires Medicare Advantage plans to provide the same zero-cost coverage for the first 3 visits
- Extends identical cost-sharing elimination to Medicaid beneficiaries
- Mandates 100% payment at the standard Medicare rate with no patient contribution for these visits
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers.
At a Glance
What This Bill Does
Requires Medicare and Medicaid to cover the first 3 primary care visits per year without cost sharing, including mental and behavioral health services.
Who Benefits
- Medicare beneficiaries
- Medicaid beneficiaries
- Mental health and behavioral health service providers
Who Bears Costs
- Federal government (Medicare program costs)
- State governments (Medicaid program costs)
- Medicare Advantage plans (required to cover without cost sharing)
Key Policy Areas
Healthcare, Mental Health, Medicare, Medicaid, Insurance Coverage
Primary Purpose
Requires Medicare and Medicaid to cover the first 3 primary care visits per year without cost sharing, including mental and behavioral health services.
Policy Domains
Legislative Strategy
"Reduce financial barriers to primary care and mental health services by eliminating cost sharing for initial visits each year"
Identified Gains
- Medicare beneficiaries
- Medicaid beneficiaries
- Mental health and behavioral health service providers
- Primary care physicians
- Care coordination service providers
- Patients seeking preventive care
Identified Costs
- Federal government (Medicare program costs)
- State governments (Medicaid program costs)
- Medicare Advantage plans (required to cover without cost sharing)
- Health insurance companies
Sponsors
Legislative Progress
IntroducedMs. Salinas (for herself, Mrs. Watson Coleman, Ms. Norton, Mr. …
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
Mental and behavioral health service providers
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
- "the_secretary"
- → Secretary of Health and Human Services
- "the_secretary"
- → Secretary of Health and Human Services
Key Definitions
Terms defined in this bill
Outpatient mental and behavioral health services, nonspecialty medical services, and care coordination services furnished for the prevention, diagnosis, treatment, or management of a physical, mental, or behavioral health condition
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology