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S 1500119th CongressIntroduced
Access to Breast Cancer Diagnosis Act of 2025
Introduced: Oct 29, 2025
Healthcare
Standard Summary
Comprehensive overview in 1-2 paragraphs
The Access to Breast Cancer Diagnosis Act of 2025 amends the Public Health Service Act to eliminate cost-sharing requirements like deductibles and copays for diagnostic and supplemental breast examinations under all group and individual health insurance plans, effective for plan years beginning January 1, 2026, while permitting prior authorization protocols and preserving stricter state laws.
Key Points
- 1Prohibits health insurance plans from imposing any cost-sharing for diagnostic breast exams used to evaluate abnormalities detected through screenings or other methods.
- 2Requires coverage without out-of-pocket costs for supplemental breast exams for high-risk individuals based on medical history or risk factors even without abnormalities.
- 3Explicitly allows health plans to maintain prior authorization requirements and utilization controls while not overriding state laws providing stronger coverage protections.
Impact Areas
Women requiring breast cancer diagnostic servicesHealth insurance providers in group and individual marketsEmployers sponsoring group health plansHigh deductible health plans with HSA eligibility
Generated by LegislativeAnalysisAI-2025 on Nov 6, 2025