The "HOPE and Mental Wellbeing Act of 2025" mandates Medicare and Medicaid to cover the first three annual primary care visits, including mental and behavioral health services, without cost-sharing.
Andrea Salinas
Representative
OR-6
The "HOPE and Mental Wellbeing Act of 2025" mandates Medicare and Medicaid to cover the first three annual primary care visits without cost-sharing. These visits encompass outpatient mental and behavioral health services, general medical care, and care coordination for physical and mental health conditions.
Medicare and Medicaid to Cover First Three Doctor Visits Annually at No Cost, Including Mental Health, Starting 2025
The HOPE and Mental Wellbeing Act of 2025 is shaking up how healthcare access works for folks on Medicare and Medicaid. Starting in 2025, the bill requires that these programs cover the first three primary care visits each year without any copays or deductibles. That's right – zero out-of-pocket costs for those initial check-ups.
Breaking Down the Barriers
This isn't just about your annual physical. The bill, in Section 2, specifically defines 'primary care' to include outpatient mental and behavioral health services, alongside regular medical check-ups and care coordination. What does care coordination mean here? Think of it as someone helping you navigate all your health needs, whether that's your blood pressure, anxiety, or both. This means you can get that nagging cough checked out, talk to someone about feeling down, and make sure all your meds are playing nicely together, all without worrying about the bill for those first three visits.
Real-World Check-Up
Imagine a retired teacher on Medicare who's been feeling more anxious lately. Under current rules, they might hesitate to see a doctor because of the copay. With the HOPE Act, they can get that initial consultation – and a couple of follow-ups – without that financial stress. Or picture a single parent on Medicaid juggling work and kids. They can now take their child in for a check-up, address their own stress levels, and get help managing a chronic condition, all under the umbrella of 'primary care,' and all without paying anything extra for the first three visits each year.
The Bottom Line
This bill aims to make it easier – and cheaper – to get basic healthcare, including mental healthcare. By removing the cost barrier for those first few visits, the HOPE Act could encourage people to address health issues earlier, rather than waiting until they become bigger, more expensive problems. But, like with any new program, the details will matter. For example, we need to make sure that providers are not scheduling unnecessary services just to fill up the three-visit quota. Overall, though, this change could mean fewer financial headaches and better health access for millions of Americans on Medicare and Medicaid.