Early Access to Screening Act
Sponsored By: Representative Lawler, Michael [R-NY-17]
Introduced
Summary
This bill would create a federal standard requiring no-cost annual screening mammography starting at age 30 across Medicare, Medicaid, and many private plans. It would set payment and timing rules and would take effect beginning January 1, 2026.
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- Medicare beneficiaries: People age 30 and older would get annual screening mammograms with no cost sharing. The bill would bar payment for screenings on women under 30 and would prohibit payment for screenings done within 11 months of a prior screening.
- Medicaid enrollees: Benchmark and benchmark-equivalent Medicaid coverage for people over 29 would have to include annual screening mammography with no deductible or cost sharing starting January 1, 2026.
- Private group and individual plans: Group health plans and individual market plans would be required to cover annual screening mammography for women over 29 with no cost sharing for 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.
Free annual mammograms for Medicaid
If enacted, beginning January 1, 2026, people on Medicaid age 30 or older would have one screening mammogram covered each year. States could not charge a deductible, copay, or similar fee for that test. States using benchmark or benchmark-equivalent plans would have to include the test with no cost sharing to enroll people.
No-cost annual mammograms for insured women
If enacted, for women age 30 or older whose coverage is subject to the preventive services rule, group and individual plans would have to cover one screening mammogram each year. The requirement would apply to plan years beginning on or after January 1, 2026. Plans would not be allowed to charge cost sharing for those covered screenings.
Medicare mammogram coverage and limits
If enacted, for screening mammography on or after January 1, 2026, Medicare would not pay for a screening given to a woman under age 30. Medicare would also not pay if a screening is done within 11 months after a previous screening. Otherwise, Medicare would pay 100 percent of the lesser of the actual charge or the applicable fee schedule amount, and beneficiaries would not owe cost-sharing for covered screenings.
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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