Sponsors (9)
The bill broadly expands no-cost access to advanced breast imaging for high-risk, dense-breast, Medicare/Tricare, and Medicaid populations to improve early detection, but it increases public/private healthcare spending, raises the risk of more false positives and follow-up procedures, and creates some implementation and plan-design frictions.
Women and other people at increased breast-cancer risk (including those with dense breasts or relevant family/history factors) will get unlimited coverage for advanced breast imaging (2D/3D mammography, MRI, ultrasound, molecular imaging) beginning Jan 1, 2026, including when a clinician determines imaging is needed under ACR/NCCN guidance.
Medicare Advantage and TRICARE enrollees receive the covered imaging without cost-sharing, reducing financial barriers for Medicare beneficiaries and veterans.
State Medicaid programs must cover unlimited screening and diagnostic imaging for eligible individuals, expanding access for low-income people who rely on Medicaid.
Insurers and taxpayers may face higher costs from unlimited imaging coverage, which could lead to higher premiums for private plans and increased federal/state spending.
More imaging will likely increase false positives and downstream diagnostic procedures for some patients, causing anxiety, additional care, and potential harms from unnecessary procedures.
Health plans that add this benefit after enactment lose grandfathered status, which could force plan design changes and affect some enrollees' existing coverage terms.
Based on analysis of 2 sections of legislative text.
Requires group and individual health plans to cover unlimited breast cancer screening and diagnostic imaging for people at increased risk or with dense breasts, per professional guidelines.
Introduced April 10, 2025 by Amy Klobuchar · Last progress April 10, 2025
Requires group health plans and individual market health insurance to cover unlimited breast cancer screening and diagnostic imaging for people at increased breast cancer risk or with heterogeneously/extremely dense breasts, using professional guideline criteria. It also allows a treating provider to order unlimited imaging for other patients who, based on the same guidelines and individual factors (age, race, family history, etc.), need extra screening or diagnostic tests. The change takes effect for plan years beginning on or after January 1, 2026, and is added to the list of required benefits that affect a plan’s grandfathered status.