Bill > HR1096

This bill, known as the HOPE and Mental Wellbeing Act of 2025, aims to improve healthcare access by requiring Medicare and Medicaid to cover the first three primary care visits each year without any out-of-pocket costs for patients, starting in 2026. The bill defines a "primary care visit" broadly as outpatient services that include mental and behavioral health services, non-specialty medical services, and care coordination for preventing, diagnosing, treating, or managing physical, mental, or behavioral health conditions. For Medicare, this means that for these three initial visits, the government will pay 100 percent of the cost, effectively eliminating copayments or deductibles for patients. The legislation modifies existing Social Security Act sections to implement this change, applying to both traditional Medicare and Medicare Advantage plans. Similarly, for Medicaid, the bill prohibits cost-sharing for these three primary care visits, making preventive and primary care more accessible and affordable for patients. By removing financial barriers, the bill seeks to encourage individuals to seek timely medical attention and preventive care, potentially improving overall health outcomes.

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https://www.congress.gov/bill/119th-congress/house-bill/1096/all-info