Sponsors (70)
Introduced November 20, 2025 by Rosa L. Delauro · Last progress November 20, 2025
The bill expands and standardizes no-cost access to advanced breast imaging for high-risk and dense-breast patients—likely improving early detection and equity—but will raise costs for insurers and Medicaid (with possible premium and state budget impacts) and may constrain imaging beyond guideline limits while creating administrative work for payers and providers.
Women at increased risk of breast cancer and those with dense breasts (including Medicare, Medicaid, VA, and TRICARE beneficiaries) will receive recommended screening and diagnostic breast imaging without cost-sharing starting in 2026.
Coverage is standardized across public programs (Medicare, Medicaid, VA, TRICARE) and private group and individual plans, reducing uneven access to covered breast imaging services.
Patients can access a broader set of imaging technologies (e.g., MRI, molecular imaging, contrast-enhanced mammography) at guideline-recommended frequencies, which may improve early detection for high-risk people.
Eliminating cost-sharing for expanded imaging will likely increase insurers' costs and could raise premiums for employers and individual purchasers.
States may face higher Medicaid expenditures to cover the expanded services, requiring budget adjustments or legislative action at the state level.
Capping imaging frequency to NCCN recommendations could prevent some patients and providers from obtaining additional imaging they believe is clinically necessary outside those guidelines.
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 guideline‑eligible or provider‑determined patients, at NCCN-recommended frequency.
Requires group and individual health plans to cover additional breast cancer screening and diagnostic imaging without any cost sharing for people at increased risk of breast cancer or for those a health care provider determines need extra imaging. Coverage must include a list of imaging technologies (mammography 2D/3D, ultrasound, MRI, molecular breast imaging, contrast-enhanced mammography, and other technologies meeting guideline criteria) and follow the frequency recommended by NCCN; the rule takes effect for plan years beginning on or after January 1, 2026. Applies to private group health plans (including ERISA plans) and health insurance issuers in the group and individual markets, and bases eligibility on clinical guidelines (ACR Appropriateness Criteria, NCCN) and BI-RADS breast density ratings or provider determination using those guidelines.