This bill would add a new federal requirement that group health plans and health insurance issuers that cover diagnostic and supplemental breast examinations cannot charge cost-sharing for those services. "Cost-sharing" is defined to include deductibles, coinsurance, copayments, and similar out-of-pocket limits. The bill defines "diagnostic breast examination" and "supplemental breast examination" using medical necessity standards aligned with National Comprehensive Cancer Network (NCCN) Guidelines and lists examples such as diagnostic mammography, breast MRI, and breast ultrasound. Plans may still use prior authorization or other utilization controls. The bill also preserves state laws that provide greater protections, adjusts the rules for grandfathered plans, and creates a safe harbor so high-deductible health plans retain Health Savings Account eligibility even if they waive the deductible for these exams. The changes would apply to plan years beginning on or after January 1, 2026. The bill was introduced in the House and referred to the Committee on Energy and Commerce and the Committee on Ways and Means.
No publicly available information.
The bill, introduced by Representative Debbie Dingell with many co-sponsors, would remove cost barriers to diagnostic and supplemental breast exams by requiring coverage without cost-sharing. It uses NCCN guidance to define medically necessary exams, allows prior authorization and stronger state protections, and includes a safe harbor for high-deductible plans to maintain HSA eligibility.
No publicly available information.