Summary

Requires that the first three primary care visits per person each year be covered without any cost-sharing under Medicare (including Medicare Advantage) and Medicaid, beginning in 2026. The bill defines “primary care visit” to include outpatient mental and behavioral health services, nonspecialty medical services, and care coordination, and updates payment/cost‑sharing rules in the Social Security Act to implement the change.

Key Points

• Eliminates patient cost‑sharing for the first three primary care visits per person each year under Medicare (including Medicare Advantage) and Medicaid.
• Defines "primary care visit" to include outpatient mental/behavioral health, nonspecialty medical visits, and care coordination.
• Takes effect starting in 2026 and requires statutory changes across the Social Security Act to update payment and cost‑sharing rules.
• Affects Medicare beneficiaries, Medicaid enrollees, primary care and behavioral health providers, and plan administrators.
• Requires payers and plan administrators to change benefits, claims systems, and provider billing practices to implement the waiver of cost sharing.
• Aims to reduce out‑of‑pocket barriers to routine and preventive care and encourage use of primary care services.
• May increase use of primary care visits and change short‑term program costs; potential long‑term savings depend on downstream effects.
• Does not create new benefit types beyond the defined primary care visit; specialty care cost‑sharing is unchanged.

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