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 and dense-breast populations to improve early detection, but does so at the cost of higher insurance and state Medicaid spending and with potential limits on clinician discretion and added administrative work.
People at increased risk of breast cancer or with dense breasts — including Medicare, Medicaid, VA, TRICARE beneficiaries and people in private group and individual plans — will receive recommended screening and diagnostic breast imaging without cost-sharing starting in 2026, removing financial barriers to guideline-recommended surveillance.
Coverage is standardized across federal public programs (Medicare, Medicaid, VA, TRICARE) and private group and individual plans, reducing uneven access and disparities in who can get recommended imaging.
Patients will be able to access a broader set of imaging technologies (MRI, molecular imaging, contrast-enhanced mammography) at frequencies aligned to ACR/NCCN guidance, which can improve early detection for high-risk people while limiting unnecessary repeat imaging.
Removing cost-sharing for expanded imaging will likely increase insurers' costs and could raise premiums for employers and individuals.
States may face higher Medicaid expenditures to cover the expanded no-cost imaging, potentially requiring new state legislation or budget adjustments.
Tying allowed frequency to the 'most recent' ACR/NCCN guidance could restrict clinicians and patients who want additional imaging beyond guideline limits, potentially delaying tests some providers deem clinically necessary.
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 specified at-risk or provider-identified individuals, effective for plan years beginning Jan 1, 2026.
Requires group and individual health insurance plans to cover additional breast cancer screening and diagnostic imaging without any cost-sharing for certain people beginning for plan years starting January 1, 2026. Coverage must include multiple imaging technologies (2D/3D mammography, ultrasound, MRI, molecular breast imaging, contrast-enhanced mammography, and others in guideline lists) at the frequency recommended by the National Comprehensive Cancer Network (NCCN) for people at increased risk or with dense breasts, and for others when a provider determines additional imaging is needed using the same guideline criteria.