Social Security and Medicare

Helping Out Patients for Emotional and Mental Wellbeing Act or the HOPE and Mental Wellbeing Act of 2025

This bill provides for coverage under Medicare and Medicaid of three primary care visits per year without cost-sharing.

Protect Social Security and Medicare Act

This bill requires a two-thirds vote before Congress may consider legislation that would reduce retirement, health, or other benefits administered by the Social Security Administration or the Centers for Medicare & Medicaid Services.

Specifically, such legislation may not be considered in either chamber of Congress until two-thirds of Members present and voting agree to a motion to consider the legislation. However, this restriction does not apply to legislation that reduces payments to Medicare Advantage plans so long as it also increases, in an amount equal to or greater than the reduction, payments made for other purposes under Medicare.

Medicare Economic Security Solutions Act

This bill modifies provisions relating to enrollment periods for Medicare medical services.

Among other things, the bill establishes a late enrollment penalty of 15% of monthly premiums and applies the penalty for a period equal to twice the number of months in each 12-month period during which the individual was not enrolled. Currently, the late enrollment penalty is 10% of monthly premiums for each 12-month period during which the individual was not enrolled, and the penalty continues to apply for as long as the individual is enrolled in Medicare medical services.

The bill also expands the special enrollment periods to individuals who have health insurance coverage other than through their employer.

This bill includes medically necessary cranial prostheses (e.g., wigs) as covered durable medical equipment under the Medicare program.

Promoting Access to Diabetic Shoes Act

This bill allows a nurse practitioner or physician assistant to fulfill documentation requirements for coverage, under Medicare, of special shoes for diabetic individuals. Under current law, such requirements may be satisfied only by a physician.

Medicare Dental, Hearing, and Vision Expansion Act of 2025

This bill provides for coverage of dental, hearing, and vision care under Medicare.

Specifically, the bill provides for coverage of

• dental and oral health services, including cleanings, treatments, and dentures;

• hearing aids and related services, including aural rehabilitation services; and

• vision services, including routine eye exams and eyeglasses.

The Centers for Medicare & Medicaid Services (CMS) must set a fee schedule for dental and oral health services based on the national median fees for similar services, and it must phase in adjustments to premiums for Medicare medical services to account for coverage of dental and oral health services over a three-year period beginning in 2028. Payment to providers of hearing aid services must be made on an assignment-related basis; payment to providers of vision services must be made under the physician fee schedule.

The bill provides funds for FY2025 for the CMS to implement the bill's changes.

Women’s Protection in Telehealth Act

This bill excludes providers of abortion-inducing drugs from participating in Medicare unless the provider is a physician who physically examines the patient, is physically present when the drug is administered, and schedules an in-person follow-up visit with the patient within 14 days of administering the drug.

Medicare and Medicaid Fraud Prevention Act

This bill provides statutory authority for the requirement that state Medicaid programs check, as part of the provider enrollment and reenrollment process, whether providers are deceased through the Social Security Administration's Death Master File. The bill requires states to continue to check this database on at least a quarterly basis after providers are enrolled.

Coordinating Care for Senior Veterans and Wounded Warriors Act

This bill requires the Department of Veterans Affairs (VA) to implement a three-year pilot program to coordinate, navigate, and manage care and benefits for veterans who are enrolled in both the Medicare program and the VA health care system.

Preserving Patient Access to Accountable Care Act

This bill extends through 2027 certain incentive payments for health professionals who participate in eligible alternative payment models under Medicare.

Rural Hospital Closure Relief Act of 2025

This bill temporarily allows additional hospitals to qualify as critical access hospitals (CAHs) that receive special payment under Medicare.

Currently, in order to qualify as a CAH under Medicare, a hospital must either (1) be located more than 35 miles (or 15 miles in mountainous regions or areas with only secondary roads) from another hospital, or (2) have been certified prior to January 1, 2006, by the state as a necessary provider of services in the area.

The bill allows a hospital to also qualify if the hospital is a small, rural hospital that (1) serves a health professional shortage area, or a high number of low-income individuals or Medicare beneficiaries; (2) has experienced financial losses for two consecutive years; and (3) attests to having a strategic plan to address financial solvency and to committing to provide a service that is in high demand in the hospital's service area. This authority expires nine years after the bill's enactment.

The Government Accountability Office must study the effects of the bill's implementation. In addition, the Medicare Payment Advisory Commission must study and recommend payment systems for rural hospitals under Medicare. The Centers for Medicare & Medicaid Services must subsequently establish a mechanism and issue guidance on how newly designated CAHs may transition to different payment models under Medicare, including any new payment models recommended by the commission.

Medicare Mental Health Inpatient Equity Act of 2025

This bill removes the 190-day lifetime limit on inpatient psychiatric hospital services under Medicare.

Improving Access to Medicare Coverage Act of 2026

This bill deems an individual receiving outpatient observation services in a hospital as an inpatient for purposes of satisfying the three-day inpatient hospital-stay requirement with respect to Medicare coverage of skilled nursing facility (SNF) services. (Generally, individuals must have been an inpatient at a hospital for at least three days in order to qualify for SNF services. An individual's time spent under observation at a hospital for purposes of determining whether the individual should be admitted does not count towards this requirement.)

Improving Care and Access to Nurses Act or the I CAN Act

This bill allows other health care providers besides physicians (e.g., nurses) to provide certain services under Medicare and Medicaid.

Among other changes, the bill (1) allows a nurse practitioner or physician assistant to fulfill documentation requirements for Medicare coverage of special shoes for diabetic individuals; (2) expedites the ability of physician assistants, nurse practitioners, and clinical nurse specialists to supervise Medicare cardiac, intensive cardiac, and pulmonary rehabilitation programs; and (3) allows nurse practitioners to certify the need for inpatient hospital services under Medicare and Medicaid.

Kids' Access to Primary Care Act of 2025

This bill modifies payments for Medicaid primary care services. Specifically, the bill applies a Medicare payment rate floor to Medicaid primary care services that are provided after the date of enactment of the bill and extends the payment rate to additional types of practitioners (e.g., obstetricians).

The Centers for Medicare & Medicaid Services must conduct a study on the number of children enrolled in Medicaid, the number of providers receiving payment for primary care services, and associated payment rates before and after the bill's implementation.