Sponsors (9)
The bill expands no‑cost, frequent breast imaging and clarifies guideline-based coverage to improve early detection and equitable access for at‑risk patients, but it raises government and insurer costs, risks more overdiagnosis, and creates implementation burdens for states and some plan enrollees.
Women and other patients at increased breast-cancer risk (including Medicare, Medicaid, TRICARE, VA, and Medicare Advantage beneficiaries) gain no‑cost access to screening and diagnostic breast imaging with no statutory frequency limits, improving chances of earlier detection.
Clinicians may order breast imaging based on individual risk factors (age, race, family history) even if a patient is not explicitly labeled 'increased risk,' supporting more individualized, timely care.
Federal programs and major payers must rely on established clinical guidelines (ACR Appropriateness Criteria, NCCN), creating clearer, more consistent criteria across plans and providers.
Mandating broader coverage and eliminating cost‑sharing will increase federal and insurer spending, which could raise premiums or taxpayer costs.
Removing frequency limits may increase imaging use, raising the risk of false positives, unnecessary follow-ups, and patient anxiety/harms from overdiagnosis.
States may need to change laws or Medicaid benchmark benefits to comply, imposing administrative and legislative costs and creating potential short‑term coverage gaps for some enrollees.
Based on analysis of 2 sections of legislative text.
Introduced April 10, 2025 by Amy Klobuchar · Last progress April 10, 2025
Requires group and individual health insurance plans and Medicare inpatient services to cover breast cancer screening and diagnostic imaging as a defined preventive service. Coverage must include specified imaging modalities (2D/3D mammography, ultrasound, breast MRI, molecular breast imaging, and other technologies) for people at increased breast cancer risk under current American College of Radiology or National Comprehensive Cancer Network guidance and for people a clinician determines need imaging because of factors such as age, race, ethnicity, or personal/family history; the coverage is required with no statutory frequency limits. The bill also reorganizes and relabels internal paragraphs and headings of the underlying statute without otherwise changing existing benefit rules or cost‑sharing mechanics.
Requires group/individual plans and Medicare inpatient services to cover breast cancer screening and diagnostic imaging for at‑risk and clinician‑identified individuals, with no frequency limits.