Primary and Behavioral Health Care Access Act of 2026
Sponsored By: Senator King, Angus S., Jr. [I-ME]
Introduced
Summary
Guarantee at least three primary care visits and three behavioral health visits per plan year with no cost-sharing. This bill would amend ERISA, the Public Health Service Act, and the Internal Revenue Code to require group health plans and health insurance issuers to provide those visits without deductibles, copays, coinsurance, or other cost-sharing, with the rule applying to plan years beginning two years after enactment.
Show full summary
- Families and patients: Would get up to 3 primary care visits and 3 behavioral health visits each plan year with no out-of-pocket cost.
- Workers and employer plans: ERISA-regulated employer plans would have to cover these visits without cost-sharing and follow the bill's rules on treatment limits and reimbursement parity.
- Insurers and markets: Group and individual market issuers must use the bill's matching definitions and coverage rules across ERISA, the Public Health Service Act, and the tax code so the minimum benefit is consistent and integrates with existing preventive coverage requirements.
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Bill Overview
Analyzed Economic Effects
2 provisions identified: 2 benefits, 0 costs, 0 mixed.
Three no-cost primary and behavioral visits
If enacted, this bill would require group health plans and individual and group market issuers to cover at least three primary care visits and three behavioral health visits each plan year with no cost-sharing. No cost-sharing means no deductibles, copays, coinsurance, or other patient cost-sharing for those visits. Plans would have to treat those visits the same as any other primary care or behavioral health visit and pay them at the same reimbursement rates. The bill defines primary care services by HCPCS codes 99201–99215 (as of Jan 1, 2009, as later modified) and lists eligible provider types like family doctors, nurse practitioners, psychiatrists, therapists, and counselors. The rule would apply for plan years beginning two years after enactment.
High-deductible plans can cover six no-cost visits
If enacted, the bill would amend the tax code to allow high-deductible health plans to cover the three primary care and three behavioral health visits described in the bill without losing high-deductible plan status. This would let those plans remain HSA-compatible while providing the six no-cost visits. The change would apply for plan years beginning two years after enactment.
Sponsors & CoSponsors
Sponsor
King, Angus S., Jr. [I-ME]
ME • I
Cosponsors
There are no cosponsors for this bill.
Roll Call Votes
No roll call votes available for this bill.
View on Congress.gov