HOPE and Mental Wellbeing Act of 2025
Sponsored By: Representative Salinas
Introduced
Summary
Three primary care visits per year with no patient cost-sharing across Medicare, Medicaid, and Medicare Advantage. The bill defines "primary care visit" to include outpatient mental and behavioral health services, nonspecialty medical services, and care coordination, effective in 2026.
Show full summary
- Medicare beneficiaries: In fee-for-service Medicare the first 3 primary care visits each year are paid at 100% of the lesser of the actual charge or the recognized outpatient payment, so beneficiaries owe no cost sharing for those visits.
- Medicare Advantage enrollees: Plans must treat the first 3 primary care visits per year as covered without patient cost sharing starting in 2026.
- Medicaid enrollees and states: States must cover the first 3 primary care visits each year with no additional cost sharing and treat them as covered Medicaid services beginning in 2026.
Your PRIA Score
Personalized for You
How does this bill affect your finances?
Sign up for a PRIA Policy Scan to see your personalized alignment score for this bill and every other piece of legislation we track. We analyze your financial profile against policy provisions to show you exactly what matters to your wallet.
Bill Overview
Analyzed Economic Effects
3 provisions identified: 3 benefits, 0 costs, 0 mixed.
Three free primary care visits in Medicaid
Starting in 2026, this bill would make your first three primary care visits each year cost $0 under Medicaid. States would have to treat these visits as covered with no copays. Primary care includes outpatient mental and behavioral health, nonspecialty medical care, and care coordination.
Three no-cost Medicare primary care visits
Starting in 2026, this bill would make your first three primary care visits each year cost $0 under Medicare. For Part B, Medicare would pay 100% of the allowed amount for up to three qualifying outpatient primary care visits, so you would owe no coinsurance. Medicare Advantage plans would also have to cover your first three primary care visits with no cost sharing. Primary care here includes outpatient mental and behavioral health, nonspecialty medical care, and care coordination. This applies only to visits billed under Medicare’s outpatient payment rules.
What counts as a primary care visit
This bill would define what counts as a primary care visit starting in 2026. It would include outpatient mental and behavioral health, nonspecialty medical care, and care coordination. This definition would decide which visits qualify for the first three no-cost visits in Medicare and Medicaid.
Sponsors & CoSponsors
Sponsor
Salinas
OR • D
Cosponsors
Watson Coleman
NJ • D
Sponsored 2/6/2025
Del. Norton, Eleanor Holmes [D-DC-At Large]
DC • D
Sponsored 2/6/2025
Doggett
TX • D
Sponsored 2/6/2025
Goldman (NY)
NY • D
Sponsored 2/6/2025
Tonko
NY • D
Sponsored 2/7/2025
Tokuda
HI • D
Sponsored 2/7/2025
Stansbury
NM • D
Sponsored 3/11/2025
Roll Call Votes
No roll call votes available for this bill.
View on Congress.govTake It Personal
Get Your Personalized Policy View
Start a Free Government Policy Watch to see how policy affects your household, then upgrade to PRIA Full Coverage for year-round monitoring.
Already have an account? Sign in