Sponsors (11)
The bill expands and standardizes no‑cost breast imaging access—likely improving early detection and reducing out‑of‑pocket costs for many beneficiaries—at the expense of higher public and insurer spending, potential increases in imaging‑related harms, and administrative burdens for states.
Women and other patients at elevated or suspected increased breast‑cancer risk (including Medicare, Medicaid, TRICARE, VA, and Medicare Advantage beneficiaries) gain broader, no‑cost access to breast screening and diagnostic imaging with no frequency limits and with clinician discretion to order imaging based on risk factors—improving chances of earlier detection and more individualized care.
People covered by Medicare, Medicaid, TRICARE, VA, and Medicare Advantage plans face lower out‑of‑pocket costs because these payers must cover the imaging services without cost‑sharing.
Clinicians, hospitals, and health systems gain clearer, more consistent clinical criteria because payers are directed to rely on ACR Appropriateness Criteria and NCCN guidelines, which can improve care consistency across insurers.
Taxpayers, insured families, and federal/state budgets face higher costs because mandated coverage and eliminated cost‑sharing will increase federal and insurer spending (which can raise premiums or taxes), and treating the requirement as applicable to grandfathered plans reduces grandfathering protections and may raise costs for enrollees in those plans.
Women and patients with chronic conditions may face more false positives, unnecessary follow‑up tests, additional procedures, radiation exposure, and anxiety because removing frequency limits can increase imaging use.
State governments may need to change laws or Medicaid benchmark benefits and incur administrative and legislative costs to comply, creating short‑term implementation burdens and potential gaps for some enrollees.
Based on analysis of 2 sections of legislative text.
Requires coverage of guideline-based breast cancer screening and diagnostic imaging for people at increased risk or when clinicians determine imaging is needed, and references this category in Medicare inpatient definitions.
Official title: Provide for health coverage with no cost-sharing for additional breast screenings for certain individuals at greater risk for breast cancer.
Introduced April 10, 2025 by Amy Klobuchar · Last progress April 10, 2025
Requires group and individual health plans and certain Medicare inpatient benefit definitions to cover a new preventive services category for breast cancer screening and diagnostic imaging. Coverage must follow the latest American College of Radiology Appropriateness Criteria or NCCN guidelines and include listed imaging modalities for people at increased risk or for whom a clinician determines imaging is needed; the change is primarily organizational plus the addition of this explicit coverage category and removes frequency limits in the statutory text as drafted.