S 1500
Access to Breast Cancer Diagnosis Act of 2025
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Bill overview
This bill, the Access to Breast Cancer Diagnosis Act of 2025, prohibits group health plans and health insurance issuers from requiring cost-sharing, such as deductibles or copays, for diagnostic and supplemental breast examinations. It ensures that these screenings and examinations are covered without out-of-pocket expenses for individuals enrolled in these plans. The bill also makes specific definitions for these examinations and applies to both new and existing health plans, with some exceptions for grandfathered plans and high-deductible plans.
Key provisions
- Prohibits cost-sharing (deductibles, coinsurance, copays) for diagnostic and supplemental breast examinations.
- Defines ‘diagnostic breast examination’ as an examination to evaluate abnormalities from screenings or other examinations.
- Defines ‘supplemental breast examination’ as a screening examination for individuals with risk factors or family history.
- Applies to new and existing health plans, including grandfathered plans.
- Includes a safe harbor for high-deductible health plans, ensuring they are not penalized for not having a deductible for these screenings.
- Provides an exception for State laws that offer greater protections for breast cancer screenings.
- Clarifies that prior authorization and utilization controls are still permitted.
- Effective date of January 1, 2026
Who is affected
- Individuals enrolled in group health plans and health insurance coverage.
- Group health plans and health insurance issuers.
Sponsors
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Primary sponsor
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119th CONGRESS — 1st Session
S. 1500
IN THE SENATE OF THE UNITED STATES
A BILL
To amend title XXVII of the Public Health Service Act to prohibit group health plans and health insurance issuers offering group or individual health insurance coverage from imposing cost-sharing requirements with respect to diagnostic and supplemental breast examinations.
This Act may be cited as the Access to Breast Cancer Diagnosis Act of 2025
.
Nothing in this section shall be construed—
In this section:
The term cost-sharing requirements means a deductible, coinsurance, copayment, and any maximum limitation on the application of such a deductible, coinsurance, copayment or similar out-of-pocket expense.
used to evaluate an abnormality seen or suspected from a screening examination for breast cancer; or
used to evaluate an abnormality detected by another means of examination.
used to screen for breast cancer when there is no abnormality seen or suspected; and
furnished based on personal or family medical history or additional factors that may increase the individual’s risk of breast cancer.
Section 1251(a)(4)(A) of the Patient Protection and Affordable Care Act (42 U.S.C. 18011(a)(4)(A)) is amended—
by striking title
and inserting title, or as added after the date of the enactment of this Act
; and
by adding at the end the following new clause:
Section 223(c)(2) of the Internal Revenue Code of 1986 is amended by adding at the end the following:
The amendments made by this section shall apply with respect to plan years beginning on or after January 1, 2026.