Sponsors (72)
Official title: To provide for health coverage with no cost-sharing for additional breast screenings for certain individuals at greater risk for breast cancer.
Introduced November 20, 2025 by Rosa L. Delauro · Last progress November 20, 2025
The bill expands no-cost, standardized access to advanced breast imaging for high-risk women across public and private plans to improve early detection, while shifting costs onto insurers, employers, states, and potentially increasing premiums and administrative burdens and limiting imaging beyond guideline caps.
Women at increased risk of breast cancer and those with dense breasts: will receive screening and diagnostic imaging without cost-sharing starting in 2026, improving access to recommended surveillance.
Medicare, Medicaid, VA, TRICARE beneficiaries and people in private group and individual plans: will have standardized coverage for these imaging services across public and private programs, reducing uneven access and coverage gaps.
High-risk patients and women: will gain access to a broader set of imaging technologies (MRI, molecular imaging, contrast-enhanced mammography) at guideline-recommended frequencies, which can improve early detection and diagnostic accuracy.
Employers, individuals, and taxpayers: removing cost-sharing is likely to increase insurance costs and could raise premiums for employer plans and individual purchasers.
State governments and Medicaid beneficiaries: states may face higher Medicaid expenditures to cover the expanded services, potentially requiring new legislation or budget adjustments.
Patients and providers: capping covered imaging frequency to NCCN recommendations could restrict additional imaging that some clinicians or patients believe is clinically necessary in individual cases.
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 eligible patients, following ACR/NCCN guidance, starting in plan years on/after Jan 1, 2026.
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 provider determines extra imaging is needed. Coverage must follow the most recent American College of Radiology Appropriateness Criteria or National Comprehensive Cancer Network (NCCN) guidelines and apply to plan years beginning on or after January 1, 2026. Specifies covered imaging modalities (2D/3D mammography, ultrasound, MRI, molecular breast imaging, contrast‑enhanced mammography, and other technologies in those guidelines) and requires plans subject to ERISA and insurance issuers in the group and individual markets to comply at the frequency recommended by NCCN or as determined by a provider using the same criteria.