Sponsors (8)
The bill expands no-cost primary care (including some mental-health) access for Medicare and Medicaid enrollees—improving affordability and preventive care—but shifts costs onto federal/state budgets and may strain provider capacity and insurer administration.
Medicare beneficiaries (including Medicare Advantage enrollees): the first three primary care visits each year will have $0 out-of-pocket cost starting in 2026, lowering direct costs and improving access to routine care.
Medicaid enrollees and low-income individuals: the first three primary care visits each year are exempted from cost-sharing, reducing financial barriers to basic and preventive care.
People needing mental and behavioral health care and care coordination: outpatient mental/behavioral health and care coordination visits count as primary care visits for the no-cost visit benefit, expanding access to mental-health services without copays for up to three visits annually.
Taxpayers and federal/state health programs: waiving copayments for millions of visits will likely increase Medicare and Medicaid spending, raising costs borne by taxpayers and the federal budget.
State governments and Medicaid programs: states may face fiscal pressure to adjust budgets or benefit designs to absorb lost cost-sharing revenue, potentially forcing trade-offs in state spending or services.
Hospitals, clinics, and healthcare workers: increased use of no-cost primary care visits could raise visit volume and create capacity strains, requiring more staff, longer hours, or investment in infrastructure.
Based on analysis of 2 sections of legislative text.
Requires Medicare Part B, Medicare Advantage, and Medicaid to cover without beneficiary cost-sharing the first three primary care visits per person each year, including outpatient mental/behavioral health and care coordination.
Introduced February 6, 2025 by Andrea Salinas · Last progress February 6, 2025
Requires Medicare Part B, Medicare Advantage plans, Medicaid state plans, and certain Medicaid alternative cost-sharing arrangements to cover, with no beneficiary cost-sharing, the first three primary care visits an individual receives each year. "Primary care visit" is newly defined to include outpatient mental and behavioral health services, nonspecialty medical services, and care coordination for prevention, diagnosis, treatment, or management of physical, mental, or behavioral conditions. These changes amend parts of the Social Security Act and take effect for the 2026 calendar year, expanding free access to a small number of primary-care and behavioral-health visits for Medicare and Medicaid enrollees and requiring program and billing updates to implement the policy.