H.R. 1096 — HOPE and Mental Wellbeing Act of 2025

This section establishes the short title of the Act as the “Helping Out Patients for Emotional and Mental Wellbeing Act” or the “HOPE and Mental Wellbeing Act of 2025.”

This section requires Medicare and Medicaid to cover the first 3 primary care visits furnished to an individual each year beginning in 2026 without cost sharing. It amends Medicare Part B to pay 100 percent of the lesser of the actual charge or the otherwise applicable payment amount for those visits, and it exempts those visits from the usual Part B deductible. It also adds the visits to Medicare Advantage cost-sharing protections so that plans may not impose cost sharing on them. As background, primary care visits are defined to include outpatient mental and behavioral health services, nonspecialty medical services, and care coordination services furnished for the prevention, diagnosis, treatment, or management of a physical, mental, or behavioral health condition. The section similarly excludes the first 3 primary care visits each year beginning in 2026 from Medicaid cost-sharing requirements, including both standard and alternative cost-sharing rules.