Sponsors (61)
The bill expands and standardizes no-cost, guideline-based breast cancer imaging for high-risk individuals—improving access and consistency of care—but increases public and private health costs and may lead to more follow-up testing, administrative burdens for states, and potential overtreatment.
Women at increased risk of breast cancer (including Medicare, Medicaid, TRICARE, VA, and private group plan beneficiaries) will gain no-cost access beginning Jan 1, 2026 to recommended screening and diagnostic breast imaging (mammography, MRI, ultrasound, and other modalities) when indicated by risk factors or provider determination, and care will be delivered according to NCCN-recommended testing
Medicare, Medicaid, TRICARE, VA, and private group plans must follow uniform coverage rules for high-risk breast imaging, reducing fragmentation and likely reducing disparities in access across payer types
Expanding no-cost coverage for advanced imaging will raise health care spending that falls on insurers, employers (including self-insured plans), and taxpayers, which could increase premiums, employer costs, or public spending
Broader imaging use may increase incidental findings and downstream follow-up procedures, creating more tests, patient anxiety, and potential overtreatment for some patients
State Medicaid programs may face administrative and legal changes to implement the new coverage rules, creating transitional costs and legislative burdens for state governments
Based on analysis of 2 sections of legislative text.
Requires group and individual health plans to fully cover guideline-recommended and provider‑ordered breast cancer screening and diagnostic imaging with no cost-sharing.
Requires group and individual health plans to cover, with no cost-sharing, recommended breast cancer screening and diagnostic imaging for people at increased breast cancer risk or with dense breasts and for any person whose health care provider determines they need such imaging. Covered tests include 2D/3D mammography, ultrasound, MRI, molecular breast imaging, contrast-enhanced mammography, and other technologies per American College of Radiology (ACR) or National Comprehensive Cancer Network (NCCN) guidance; imaging frequency follows NCCN recommendations and the rule applies to plan years beginning on or after January 1, 2026. Applies to group health plans (including ERISA plans) and health insurance issuers offering group or individual coverage, and removes cost-sharing requirements for the specified screening and diagnostic breast imaging when criteria are met or a provider documents need.
Introduced November 20, 2025 by Rosa L. Delauro · Last progress November 20, 2025