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Congress·In Committee·10 months ago

Senate Bill Would Eliminate Out-of-Pocket Costs for Follow-Up Breast Cancer Tests

Also known as: Access to Breast Cancer Diagnosis Act of 2025

Legislative Progress

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Impacts

Positive Impacts(3)
Chronic Illness
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Key Points

  • Would ban deductibles, copays, and coinsurance for follow-up breast cancer tests in most private health plans.
  • Covers “diagnostic” exams (like a diagnostic mammogram, breast MRI, or ultrasound) when something looks suspicious on a screening or other exam.
  • Covers “supplemental” exams (like MRI or ultrasound) for higher-risk people even when nothing looks abnormal on a screening.
  • Plans could still require prior approval and other reasonable limits, and state laws with stronger protections would still apply.
  • Starts for plan years beginning on or after January 1, 2026, and includes older “grandfathered” plans; keeps HSA-eligible plans from losing status.
HealthcareConsumer Protection

Milestones

2 milestones2 actions
Apr 28, 2025Senate

Read twice and referred to the Committee on Health, Education, Labor, and Pensions.

Apr 28, 2025

Introduced in Senate

What Happens Next

Projected impacts based on AI analysis

2026-01-01

No-cost sharing starts for diagnostic and supplemental breast exams in most private plans

Starting with plan years that begin on or after Jan 1, 2026, people enrolled in covered group or individual private plans should no longer be billed deductibles, copays, or coinsurance for covered diagnostic and supplemental breast exams.

2026-01-01

High-deductible plans can cover these breast exams before the deductible and stay HSA-eligible

If you have an HSA-eligible high-deductible plan, the plan can pay for these exams up front (with $0 cost-sharing) without disqualifying the plan from HSA rules, for plan years beginning on or after Jan 1, 2026.

During 2025 for 2026 plan designs and again each renewal cycle

Plans may update prior authorization and medical review rules for these exams

Even with $0 cost-sharing, your plan can still require approval before a breast MRI/ultrasound or require that the test meets medical-need guidelines, so some people may need their doctor to submit paperwork or try a different test first.

Related News

3 articles
The Hill·4 months ago

Lawmakers anxious to advance breast cancer bill — when shutdown ends

Reps. Debbie Dingell and Beth Van Duyne discussed how the government shutdown is halting progress on the bipartisan Access to Breast Cancer Diagnosis Act. The bill seeks to eliminate out-of-pocket costs for follow-up diagnostic tests, a move supported by 90% of Republican voters in recent polls.

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Radiology Business·10 months ago

Bipartisan Bill Reintroduced to Eliminate Cost Barriers for Supplemental Breast Imaging

Lawmakers have reintroduced the Access to Breast Cancer Diagnosis Act, which would mandate that health insurers cover supplemental imaging services like MRI and ultrasound without patient cost-sharing. The bill aims to close the gap where follow-up tests are often not covered by the ACA.

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Health Imaging·10 months ago

Bipartisan bill would require insurers to cover supplemental breast imaging nationwide

The Access to Breast Cancer Diagnosis Act, led by Reps. Dingell and Fitzpatrick, seeks to eliminate financial barriers to diagnostic imaging. While screening mammograms are covered under current law, follow-up tests can cost patients over $1,000, leading many to forgo necessary care.

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Source Information

Document Type

Congressional Bill

Official Title

Access to Breast Cancer Diagnosis Act of 2025

Bill NumberS 1500
Congress119th Congress
ChamberSenate
Latest ActionRead twice and referred to the Committee on Health, Education, Labor, and Pensions.

Sponsor

Cosponsors

(6)
D: 3R: 3

Analysis generated by AI. While we strive for accuracy, this should not be considered legal or professional advice. Always verify information with official government sources.