Congress removes cost barriers to breast cancer diagnosis for all insured Americans
S. 1500 — Access to Breast Cancer Diagnosis Act of 2025 · Filed by Jeanne Shaheen (D-NH) · 10 cosponsors · Introduced Apr 28, 2025 · Referred to committee
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What it does
This bill requires all health insurance plans to cover diagnostic and supplemental breast examinations with zero out-of-pocket costs (no copays, deductibles, or coinsurance) starting January 1, 2026. It applies to group plans, individual coverage, and grandfathered plans, while allowing insurers to use prior authorization and utilization controls. The bill aligns coverage with National Comprehensive Cancer Network guidelines for medically necessary breast imaging used to evaluate abnormalities or assess risk in high-risk individuals.
Why we flagged it
The bill's core function is to mandate zero-cost coverage for a specific diagnostic service category, following the preventive-care model established by the ACA. It is a straightforward health insurance coverage requirement, not a tax provision, appropriation, or commemorative measure.
What the text implies
- Eliminates cost-sharing only for diagnostic/supplemental breast exams; does not address treatment costs, potentially creating a gap where diagnosis is free but follow-up care remains expensive.
- Defers to NCCN guidelines for medical necessity, which may evolve over time and could expand or contract the scope of covered services without legislative amendment.
The full analysis lists 4 implications of this text.
Who stands to gain
diagnostic imaging providers (radiology centers, hospital imaging departments); breast imaging equipment manufacturers; health insurance plans (reduced claims from early detection may lower downstream treatment costs)