Bill would mandate free breast diagnostic exams

What does this do?

This bill would require health insurance plans to cover two types of breast exams at no cost to the patient: diagnostic exams ordered after a suspicious finding, and supplemental exams ordered for people at higher risk due to personal or family history. Both types must be considered medically necessary and appropriate under National Comprehensive Cancer Network Guidelines. Insurers could still require prior authorization before approving these exams.

Who does it affect?

This rule would apply to most health insurance plans, including employer-sponsored group plans, individual plans, grandfathered health plans, and high-deductible health plans paired with Health Savings Accounts. It would affect patients whose plans cover plan years starting on or after January 1, 2026.

Why does it matter?

Without this requirement, patients in qualifying plans may currently face out-of-pocket costs for these types of breast exams. If the bill becomes law, those costs would no longer be charged to the patient for covered exams.

Where does it stand?