Sponsors (8)
The bill expands no‑cost access to up to three primary‑care visits (including outpatient mental/behavioral health) for Medicare and Medicaid enrollees—improving preventive care and lowering patient costs—while increasing program spending and creating incentives for plans or states to offset costs through tighter networks, benefit limits, or eligibility changes, plus added provider administrative burden.
Medicare, Medicare Advantage, and Medicaid enrollees will get their first three primary-care visits each year with no cost‑sharing, increasing affordable access to routine and preventive care for millions of beneficiaries.
Medicare beneficiaries will face lower out‑of‑pocket costs for routine primary-care (no cost‑sharing for the first three visits beginning in 2026), reducing financial barriers to care for seniors.
Outpatient mental and behavioral health services are included in the law's definition of primary care, improving affordable access to early mental‑health and substance‑use treatment and follow‑up care.
Federal and state program spending will increase to cover waived cost‑sharing, which could require higher taxes or divert funds from other programs or services.
Medicare Advantage plans and some state Medicaid programs may try to offset added costs by narrowing provider networks, increasing utilization controls, or restricting other benefits, which could reduce access or quality of care.
If states face higher Medicaid costs, they may tighten eligibility or cut optional benefits to control budgets, potentially reducing coverage for vulnerable populations.
Based on analysis of 2 sections of legislative text.
Requires Medicare, Medicare Advantage, and Medicaid to cover the first three annual "primary care visits" without cost-sharing and defines those visits to include mental/behavioral health and care coordination.
Requires Medicare, Medicare Advantage, and Medicaid to cover the first three "primary care visits" each year without any patient cost-sharing beginning in 2026. It also defines "primary care visit" to include outpatient mental/behavioral health services, nonspecialty medical services, and care coordination services, and adjusts payment and plan benefit rules to reflect the coverage change.
Introduced February 6, 2025 by Andrea Salinas · Last progress February 6, 2025