Access to Breast Cancer Diagnosis Act of 2025
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Progress
Where this bill stands in the legislative process.
- Introduced
- Passed Senate
- Passed House
- To President
- Became Law
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.
Bill text
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Sponsors
Official sponsors from legislative records.
11 on record
Primary sponsor
Cosponsors
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