Sponsor
Joseph Neguse
Representative · D-CO
Representative · D-CO
The bill substantially expands no-cost annual mammography for most insured women—improving access and reducing out-of-pocket costs—while raising public/private costs and imposing age- and frequency-based limits that may reduce access for some and add administrative burdens.
Women with Medicare (age 30+), women enrolled in Medicaid, and women in group or individual private plans will get annual screening mammograms with no cost-sharing beginning Jan 1, 2027, improving access to preventive breast cancer screening and reducing out-of-pocket costs.
State Medicaid programs can receive enhanced federal matching funds (FMAP) for the newly covered screening mammography benefit, reducing net state costs for expanding coverage and encouraging uptake among low-income enrollees.
Medicare’s strict limit of one paid screening mammogram per 11-month period may cut down on duplicate testing and reduce unnecessary program spending.
Taxpayers, federal programs, and private insurers will face higher costs from broader no-cost coverage, which could lead to increased federal/state spending or higher insurance premiums for middle-class families.
Women on Medicare may have needed follow-up or more frequent screening delayed by the 11-month frequency limit, forcing some to pay out-of-pocket or skip care.
Women under 30 who previously relied on Medicare coverage for screening mammography will lose that coverage after Jan 1, 2027, shifting costs to younger beneficiaries or leaving some without affordable access.
Based on analysis of 2 sections of legislative text.
Requires annual screening mammograms without cost-sharing for women 30+ across Medicare, Medicaid, and private plans starting Jan 1, 2027; bars Medicare payment for under-30s.
Requires annual screening mammography coverage without cost-sharing for women age 30 and older across Medicare, Medicaid, and private group and individual health plans, effective January 1, 2027. It also bars Medicare payment for screening mammograms for women under age 30 and limits Medicare-paid screening to no more than one screening per 11-month period for women 30 and older. Medicaid is required to treat annual mammography for women over 29 as a covered preventive/diagnostic service eligible for the enhanced FMAP; private and employer plans must eliminate beneficiary cost-sharing for these annual screenings for plan years beginning on or after January 1, 2027. The law also standardizes certain cross-references in Medicare statutory text.
Official title: To amend titles XVIII and XIX of the Social Security Act and title XXVII of the Public Health Service Act to provide for no-cost coverage for annual screening mammography beginning at 30 years of age.
Introduced August 13, 2026 by Joseph Neguse · Last progress August 13, 2026