Access to Breast Cancer Diagnosis Act of 2025
Sponsored By: Senator Shaheen, Jeanne [D-NH]
Introduced
Summary
No cost-sharing for diagnostic and supplemental breast examinations: The Access to Breast Cancer Diagnosis Act of 2025 would ban patient cost-sharing for medically necessary diagnostic and supplemental breast exams to reduce financial barriers to follow-up testing.
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- Patients and families: People with an abnormal screening result or higher breast cancer risk would not pay a deductible, copayment, coinsurance, or similar out-of-pocket charge for medically necessary diagnostic or supplemental breast exams. Exams must follow National Comprehensive Cancer Network guidelines.
- Health plans and insurers: Group and individual plans could not impose cost-sharing for these exams but may require timely prior authorization or other utilization controls. State laws that provide greater protections would still apply.
- High-deductible plans and HSA holders: For plan years beginning on or after January 1, 2026, plans would get a safe harbor so excluding these exams from a deductible does not disqualify a plan as a high-deductible health plan for Health Savings Account eligibility.
- Grandfathered plans: The coverage requirement would be added to the rules that apply to grandfathered health plans so they are subject to the same ban on cost-sharing.
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Bill Overview
Analyzed Economic Effects
2 provisions identified: 2 benefits, 0 costs, 0 mixed.
No cost-sharing for breast exams
If enacted, insurers could not make you pay copays, coinsurance, or deductibles for diagnostic or supplemental breast exams. This covers diagnostic mammograms, breast MRI, and breast ultrasound when medically appropriate. It would apply to employer and individual plans, including some grandfathered plans. Plans could still require timely prior authorization. The rule would start for plan years beginning January 1, 2026. State laws that give more protection would still apply.
Keep HSA eligibility for breast exams
If enacted, high-deductible health plans would not lose HSA eligibility if they exempt diagnostic or supplemental breast exams from the deductible. This safe harbor would apply to plan years starting January 1, 2026.
Sponsors & CoSponsors
Sponsor
Shaheen, Jeanne [D-NH]
NH • D
Cosponsors
Katie Britt
AL • R
Sponsored 4/28/2025
Shelley Capito
WV • R
Sponsored 4/28/2025
Sen. Ossoff, Jon [D-GA]
GA • D
Sponsored 9/9/2025
Roger Wicker
MS • R
Sponsored 10/22/2025
Sen. Schiff, Adam B. [D-CA]
CA • D
Sponsored 12/10/2025
Sen. Whitehouse, Sheldon [D-RI]
RI • D
Sponsored 1/12/2026
Sen. Gillibrand, Kirsten E. [D-NY]
NY • D
Sponsored 1/27/2026
Sen. Fetterman, John [D-PA]
PA • D
Sponsored 4/29/2026
Roll Call Votes
No roll call votes available for this bill.
View on Congress.gov