Sponsors (70)
Introduced November 20, 2025 by Rosa L. Delauro · Last progress November 20, 2025
The bill expands equitable, no-cost access to advanced breast imaging and aligns coverage with expert guidelines to improve detection, but does so at the likely expense of higher insurance and Medicaid costs and added administrative constraints that could limit some clinical discretion.
Women at increased risk for breast cancer and people with dense breasts (including Medicare, Medicaid, VA/TRICARE, and many private plan enrollees) will be able to receive screening and follow-up diagnostic imaging without any cost-sharing beginning in 2026, removing a financial barrier to recommended surveillance.
Patients will have coverage for a broader set of advanced imaging technologies (MRI, molecular imaging, contrast-enhanced mammography) at frequencies aligned to NCCN/ACR guidance, which could improve early detection for high-risk people while reducing unnecessary repeat imaging.
Coverage is standardized across public programs (Medicare, Medicaid, VA, TRICARE) and private group and individual plans, reducing uneven access to guideline-recommended breast imaging.
Eliminating cost-sharing for these imaging services will likely increase overall insurance spending and could lead to higher premiums for employers and individual enrollees.
States may face higher Medicaid expenditures to cover the expanded no-cost imaging, requiring state budget adjustments or legislation to finance the change.
Linking coverage to the 'most recent' ACR/NCCN guidance could create ongoing administrative and operational burdens for insurers, providers, and health systems as they track, interpret, and implement guideline changes.
Based on analysis of 2 sections of legislative text.
Requires group and individual health plans to cover additional breast cancer screening and diagnostic imaging without cost-sharing for higher-risk people or when a clinician determines it's needed, per ACR/NCCN guidance.
Requires group and individual health plans to cover additional breast cancer screening and diagnostic imaging without any cost-sharing for people at increased risk or when a clinician determines it’s needed, using the most recent ACR Appropriateness Criteria or NCCN guidelines and BI‑RADS density categories. Coverage must include specified imaging technologies at the frequency recommended by NCCN and takes effect for plan years beginning on or after January 1, 2026.