IllinoisHB5001104th General Assembly (2025–2026)HouseWALLET

INS-MAMMOGRAM COVERAGE

Sponsored By: Sponsor information unavailable

Became Law

Summary

Amends the Illinois Insurance Code. Requires every insurer to provide in each group or individual policy, contract, or certificate of insurance issued or renewed for persons who are residents of the State, coverage for screening by low-dose mammography for all patients 30 (instead of 35) years of age or older for the presence of occult breast cancer within the provisions of the policy, contract, or certificate. Requires coverage for a baseline mammogram for patients 30 to 34 (instead of 35 to 39) years of age and an annual mammogram for patients 35 (instead of 40) years of age or older. Effective January 1, 2027.

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Bill Overview

Analyzed Economic Effects

4 provisions identified: 1 benefits, 1 costs, 2 mixed.

Breast reconstruction and prostheses after mastectomy

Beginning January 1, 2028, if your Illinois policy covers mastectomy, it must also cover breast reconstruction, surgery on the other breast for symmetry, prostheses, and treatment of complications like lymphedema. These benefits use the same deductible and coinsurance rules as the mastectomy under your plan. If there is no cancer found, coverage can be limited to services received within two years after the mastectomy.

More imaging for dense breast tissue

Starting January 1, 2028, plans issued or renewed in Illinois must cover full-breast ultrasound and MRI when a mammogram shows dense or heterogeneous tissue, or when a provider says it is medically necessary. A physician, nurse practitioner, or physician assistant can make that call. For group plans issued or renewed on or after that date, coverage also includes molecular breast imaging in the same cases. Screening MRI is covered when a licensed physician says it is medically necessary.

Free mammograms and follow-up imaging

Illinois-regulated health plans must cover breast cancer screening. Ages 35–39 get one baseline low-dose mammogram. Ages 40+ get a mammogram every year. Under 40, plans cover mammograms when your provider says they are medically necessary due to risk. Starting January 1, 2028, screening and related diagnostic imaging are covered with no copay, deductible, or coinsurance and do not count toward annual or lifetime maximums. Diagnostic mammograms have had no cost-sharing since January 1, 2020. To keep Health Savings Account status, some high‑deductible plans may still apply normal deductibles.

Out-of-network imaging may cost you

Starting January 1, 2028, if you do not follow your plan’s network rules for breast imaging, the no‑cost rule does not apply. Your plan’s out‑of‑network terms then control what you pay. Those terms must be at least as favorable as for other radiology tests.

Sponsors & Cosponsors

Sponsors

There is no primary sponsor on record.

Cosponsors

  • Camille Y. Lilly

    Affiliation unavailable

  • Daniel Didech

    Affiliation unavailable

  • David Koehler

    Affiliation unavailable

  • Debbie Meyers-Martin

    Affiliation unavailable

  • Elgie R. Sims, Jr.

    Affiliation unavailable

  • Elizabeth "Lisa" Hernandez

    Affiliation unavailable

  • Emanuel "Chris" Welch

    Affiliation unavailable

  • Graciela Guzmán

    Affiliation unavailable

  • Gregg Johnson

    Affiliation unavailable

  • Janet Yang Rohr

    Affiliation unavailable

  • Jawaharial Williams

    Affiliation unavailable

  • Joyce Mason

    Affiliation unavailable

  • Justin Cochran

    Affiliation unavailable

  • Katie Stuart

    Affiliation unavailable

  • Kelly M. Cassidy

    Affiliation unavailable

  • Kevin John Olickal

    Affiliation unavailable

  • Kimberly Du Buclet

    Affiliation unavailable

  • Laura Faver Dias

    Affiliation unavailable

  • Lisa Davis

    Affiliation unavailable

  • Mary Edly-Allen

    Affiliation unavailable

  • Mary Gill

    Affiliation unavailable

  • Mattie Hunter

    Affiliation unavailable

  • Maura Hirschauer

    Affiliation unavailable

  • Michael Crawford

    Affiliation unavailable

  • Michael W. Halpin

    Affiliation unavailable

  • Michelle Mussman

    Affiliation unavailable

  • Nabeela Syed

    Affiliation unavailable

  • Nicolle Grasse

    Affiliation unavailable

  • Norma Hernandez

    Affiliation unavailable

  • Rita Mayfield

    Affiliation unavailable

  • Robert F. Martwick

    Affiliation unavailable

  • Sara Feigenholtz

    Affiliation unavailable

  • Sharon Chung

    Affiliation unavailable

  • Sonya M. Harper

    Affiliation unavailable

  • Steve Stadelman

    Affiliation unavailable

  • Suzanne M. Ness

    Affiliation unavailable

  • Suzy Glowiak Hilton

    Affiliation unavailable

  • Theresa Mah

    Affiliation unavailable

  • Will Guzzardi

    Affiliation unavailable

  • Yolonda Morris

    Affiliation unavailable

Roll Call Votes

All Roll Calls

Yes: 348 • No: 6

House vote 5/28/2026

Senate Floor Amendment No. 1 House Concurs

Yes: 113 • No: 0

House vote 5/26/2026

Senate Floor Amendment No. 1 Motion to Concur Recommends Be Adopted Insurance Committee;

Yes: 15 • No: 0

Senate vote 5/21/2026

Third Reading - Passed;

Yes: 56 • No: 0

Senate vote 5/13/2026

Senate Floor Amendment No. 1 Recommend Do Adopt Insurance;

Yes: 11 • No: 0

Senate vote 5/6/2026

Do Pass Insurance;

Yes: 9 • No: 0

House vote 4/17/2026

Third Reading - Short Debate - Passed

Yes: 104 • No: 0

House vote 4/15/2026

House Floor Amendment No. 2 Recommends Be Adopted Insurance Committee;

Yes: 15 • No: 0

House vote 4/14/2026

House Floor Amendment No. 1 Recommends Be Adopted Insurance Committee;

Yes: 15 • No: 0

House vote 3/24/2026

Do Pass / Short Debate Insurance Committee;

Yes: 10 • No: 6

Actions Timeline

  1. Public Act . . . . . . . . . 104-0783

    8/7/2026House
  2. Effective Date January 1, 2028

    8/7/2026House
  3. Governor Approved

    8/7/2026House
  4. Sent to the Governor

    6/26/2026House
  5. Added as Alternate Co-Sponsor Sen. Mattie Hunter

    6/1/2026Senate
  6. Added as Alternate Co-Sponsor Sen. Elgie R. Sims, Jr.

    6/1/2026Senate
  7. Added as Alternate Co-Sponsor Sen. Steve Stadelman

    6/1/2026Senate
  8. Added as Alternate Co-Sponsor Sen. David Koehler

    5/31/2026Senate
  9. Added as Alternate Co-Sponsor Sen. Mary Edly-Allen

    5/31/2026Senate
  10. Added as Alternate Co-Sponsor Sen. Sara Feigenholtz

    5/31/2026Senate
  11. Added as Alternate Co-Sponsor Sen. Suzy Glowiak Hilton

    5/31/2026Senate
  12. Added as Alternate Co-Sponsor Sen. Robert F. Martwick

    5/31/2026Senate
  13. Added as Alternate Co-Sponsor Sen. Michael W. Halpin

    5/31/2026Senate
  14. Added Co-Sponsor Rep. Debbie Meyers-Martin

    5/28/2026House
  15. Added Co-Sponsor Rep. Justin Cochran

    5/28/2026House
  16. Passed Both Houses

    5/28/2026House
  17. House Concurs

    5/28/2026House
  18. Senate Floor Amendment No. 1 House Concurs 113-000-000

    5/28/2026House
  19. Senate Floor Amendment No. 1 Motion to Concur Recommends Be Adopted Insurance Committee; 015-000-000

    5/26/2026House
  20. Senate Floor Amendment No. 1 Motion to Concur Rules Referred to Insurance Committee

    5/25/2026House
  21. Senate Floor Amendment No. 1 Motion to Concur Referred to Rules Committee

    5/22/2026House
  22. Senate Floor Amendment No. 1 Motion Filed Concur Rep. Nabeela Syed

    5/22/2026House
  23. Placed on Calendar Order of Concurrence Senate Amendment(s) 1

    5/21/2026House
  24. Arrived in House

    5/21/2026House
  25. Third Reading - Passed; 056-000-000

    5/21/2026Senate

Bill Text

  • Engrossed

  • Enrolled

  • House Amendment 1

  • House Amendment 2

  • Introduced

  • Senate Amendment 1

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