Sponsors (14)
The bill secures broader, enforceable coverage and patient‑centered choice for breast reconstruction after mastectomy, but that expansion may raise premiums and out‑of‑pocket costs and create network, payment, and administrative pressures that could limit timely access in practice.
People with breast cancer (especially women and those with chronic conditions) gain guaranteed coverage for a full range of reconstruction options (implants, flap procedures, fat grafting, prostheses) and plans must keep at least one in‑network provider for each modality, improving access to reconstructive care.
Patients (and their clinicians) retain authority to decide on reconstruction approach without insurer interference, preserving medical decision‑making and clinical autonomy.
Parity protections reduce the ability of plans to drop or deny reconstruction coverage solely to avoid the mandate, helping protect continuity of coverage.
Insured individuals (families and taxpayers) may face higher premiums or overall plan costs if insurers raise prices to cover expanded reconstruction benefits.
Patients could still face significant out‑of‑pocket costs because plans may apply deductibles and coinsurance to complex reconstruction procedures.
Some insurers may respond by narrowing networks or lowering provider payment rates, which could limit timely access to qualified reconstructive surgeons despite the in‑network provider requirement.
Based on analysis of 2 sections of legislative text.
Requires group health plans and issuers covering breast cancer treatment to cover all recognized breast/chest reconstruction options, prostheses, and related complication care, with notice and access rules.
Requires group health plans and health insurance issuers that cover medical and surgical treatment for breast cancer to also cover a full range of breast and chest wall reconstruction options, related prostheses, and treatment of physical complications (including lymphedema compression items). Coverage must include all reconstruction modalities and procedural variations listed in HCPCS Level I, allow reconstruction at all stages (including flat closure), and may include standard cost-sharing; plans must provide written notice to enrollees and make at least one in-network provider available for each modality or type. Adds matching requirements to the Public Health Service Act, ERISA, and the Internal Revenue Code, bans plan maneuvers taken solely to avoid the coverage rules or to incentivize care inconsistent with them, requires a GAO report within one year on access gaps (including microsurgical reconstruction), and becomes effective for plan years beginning on or after enactment (with a savings rule for existing collective-bargaining agreements).
Introduced October 24, 2025 by Kat Cammack · Last progress October 24, 2025