Sponsor
Michael Lawler
Representative · R-NY
Representative · R-NY
The bill expands annual, no-cost mammography to women beginning at age 30—improving access, equity, and reducing out-of-pocket costs—while increasing public and private program costs, administrative complexity, and the risk of more false-positive follow-ups.
Women aged 30 and older (including Medicare and Medicaid enrollees) gain access to an annual, no-cost screening mammogram starting Jan 1, 2026, improving early detection of breast cancer and preventive care uptake.
Medicare beneficiaries will no longer owe cost-sharing for covered screening mammography performed on or after Jan 1, 2026, reducing out-of-pocket spending for seniors who receive these screenings.
State Medicaid enrollees are guaranteed annual mammography as a mandatory covered preventive benefit with no cost-sharing, advancing equity in preventive care for low-income individuals.
Taxpayers, insurers, and state governments may face higher program and coverage costs to pay for more screenings, potentially leading to increased premiums or additional federal/state spending.
Allowing a screening every 11 months may increase utilization and create administrative complexity for providers and payers, adding burden for hospitals, health systems, and healthcare workers.
Expanding routine screening to begin at age 30 may raise the number of false positives and follow-up diagnostic procedures, causing anxiety and possible unnecessary interventions for some women.
Based on analysis of 2 sections of legislative text.
Requires no-cost annual screening mammography starting at age 30 for Medicare, Medicaid, and private group and individual plans, effective Jan 1, 2026.
Official title: To amend titles XVIII and XIX of the Social Security Act and title XXVII of the Public Health Service Act to provide no-cost coverage for annual screening mammography beginning at 30 years of age.
Introduced April 28, 2026 by Michael Lawler · Last progress April 28, 2026
Requires Medicare, Medicaid, and private group and individual health plans to cover annual screening mammography with no cost-sharing beginning at age 30, effective January 1, 2026. Also sets payment and frequency rules for Medicare and adds screening mammography to required Medicaid and private-plan preventive services. Removes patient cost-sharing for covered screening mammograms for people aged 30 and older, requires Medicare to pay 100% of the lesser of charge or fee schedule for such screenings, and prohibits state Medicaid cost-sharing for the benefit starting January 1, 2026.