Sponsors (14)
The bill secures comprehensive, physician‑guided reconstruction coverage and requires network availability and beneficiary notice—improving care for breast cancer patients—but could raise insurance/employer costs, leave patients with out‑of‑pocket expenses, and still fall short in specialist-scarce areas.
People with breast cancer (including transgender and cisgender women) gain guaranteed coverage for comprehensive breast/chest wall reconstruction options—implants, flap procedures, external prostheses, and lymphedema supplies—under applicable federal law.
Patients retain the right to make reconstruction decisions in consultation with their attending physician and be medically evaluated for candidacy without plan interference.
At least one in‑network provider must be available for each reconstruction modality/type/variation, which can improve timely access to covered reconstruction services.
Insurers and employers may face higher costs to expand network capacity and cover more procedures and supplies, which could lead to higher premiums or increased employer plan costs.
Plans can still apply annual deductibles and coinsurance, so patients may face significant out‑of‑pocket costs for complex reconstruction despite guaranteed coverage.
Compliance may be difficult in areas lacking specialists (e.g., microsurgical reconstruction), meaning real-world access could remain limited for patients in rural or underserved communities.
Based on analysis of 2 sections of legislative text.
Requires group health plans and issuers that cover breast cancer treatment to cover comprehensive breast/chest wall reconstruction, prostheses, symmetry surgery, and treatment of complications.
Introduced October 24, 2025 by Kat Cammack · Last progress October 24, 2025
Requires group health plans and health insurance issuers that cover breast cancer treatment to also cover a broad set of breast/chest wall reconstruction services, prostheses, symmetry procedures, and treatment for physical complications when a patient elects reconstruction related to their care. Plans may apply ordinary deductibles and coinsurance, must provide written notice at enrollment and annually, and must have at least one in-network provider for each reconstruction modality or procedural variation. The law applies across the Public Health Service Act, ERISA, and the Internal Revenue Code for plan years beginning on or after enactment and directs the Comptroller General to report within one year on access gaps, including access to microsurgical reconstruction.