Sponsors
The bill increases access to and coverage of Lp(a)/ApoB cardiovascular risk testing—reducing financial barriers and enabling earlier detection for many—while shifting near‑term costs to insurers, taxpayers, and state Medicaid programs and raising the risk of increased utilization and downstream overdiagnosis.
Medicare, Medicaid, and eligible private-plan enrollees who meet risk criteria will get lipoprotein(a) and apolipoprotein B testing without cost‑sharing, lowering financial barriers to screening for older and low‑income Americans.
People with undiagnosed high Lp(a)/ApoB and heart‑attack survivors will have improved targeted screening and follow‑up, enabling earlier intervention that could reduce individual cardiovascular risk and mortality.
Requiring coverage across payers and prioritizing cardiovascular risk detection could support broader risk stratification and prevention efforts, potentially lowering future heart attack and stroke rates at the population level.
Health plans and state Medicaid programs may face higher near‑term costs to cover increased testing, which could translate into higher premiums, greater taxpayer burden, or state budget pressure.
Mandatory expanded testing could increase utilization of tests with uncertain incremental benefit for some patients, leading to overdiagnosis, additional follow‑up procedures, unnecessary treatments, and patient anxiety.
States that use benchmark Medicaid plans will be required to include these tests, reducing state flexibility to control Medicaid benefits and potentially straining state finances.
Based on analysis of 3 sections of legislative text.
Requires private plans, Medicare, and Medicaid to cover Lp(a) and ApoB testing for people with specified cardiovascular risk factors and eliminates Medicare/Medicaid cost-sharing.
Introduced April 14, 2026 by Sheila Cherfilus-McCormick · Last progress April 14, 2026
Requires private group and individual health plans, Medicare, and Medicaid to cover testing for lipoprotein(a) (Lp(a)) and apolipoprotein B (ApoB) for people with certain cardiovascular-risk histories or diagnoses, and removes beneficiary cost-sharing for those tests under Medicare and Medicaid. Coverage takes effect for plan years and Medicare/Medicaid items and services beginning 180 days after the law is enacted. The law also finds that Lp(a) and ApoB are important predictors of cardiovascular risk that routine cholesterol panels often miss, and it makes Medicaid coverage of these tests mandatory for eligible individuals (including benchmark and benchmark-equivalent plans).