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119-hr-8551119th CongressWALLET

Early Access to Screening Act

Sponsored By: Representative Lawler, Michael [R-NY-17]

Introduced

Summary

No-cost annual screening mammography starting at age 30 would be required across Medicare, Medicaid, and private group and individual plans. It would align coverage rules across payers, add an 11-month frequency limit for Medicare, and take effect for plan years and services starting January 1, 2026.

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  • Medicare: Would bar payment for screening mammograms on people under 30. For people 30 and older it would stop payment for a screening done within 11 months of a prior screening and require Medicare to cover 100 percent of the lesser of the actual charge or the Part B fee schedule for these screenings.
  • Medicaid: Would add annual screening mammography for people age 30 and older to mandatory Medicaid benefits and prohibit any cost sharing for that service. States could not use benchmark or benchmark-equivalent coverage unless it includes the no-cost annual screening.
  • Private plans: Group health plans and individual market policies would be required to provide annual screening mammography at no cost for women 30 and older, applied to plan years beginning on or after January 1, 2026.

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Bill Overview

Analyzed Economic Effects

3 provisions identified: 2 benefits, 0 costs, 1 mixed.

Medicaid: no-cost yearly mammograms

If enacted, Medicaid would have to cover one screening mammogram each year for people over age 29 starting January 1, 2026. States could not charge co-pays or similar costs for that service. If a state uses benchmark or benchmark-equivalent plans, those plans would also have to include the mammogram and not charge cost sharing starting January 1, 2026.

Private plans: no-cost yearly mammograms

If enacted, group and individual health plans would have to cover one screening mammogram each year for women over 29. This requirement would apply to plan years that begin on or after January 1, 2026. The bill would also eliminate cost-sharing for that preventive service under those plans.

Medicare: free mammograms, with limits

If enacted, and you have Medicare Part B, you would not owe cost-sharing for covered screening mammograms performed on or after January 1, 2026. Medicare would pay 100% of the lesser of the provider's charge or the Part B fee-schedule amount for those screenings. Medicare would not pay for screening mammograms for women under 30. For women 30 and older, Medicare would not pay for a screening done within 11 months of a prior screening.

Sponsors & CoSponsors

Sponsor

Lawler, Michael [R-NY-17]

NY • R

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

No roll call votes available for this bill.

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