Access to Breast Cancer Diagnosis Act of 2025 | ChamberLight
Bills · S 1500
IN COMMITTEE· 119TH CONGRESS
Senate BillS 1500Health
Access to Breast Cancer Diagnosis Act of 2025
INTRO APR 28· LAST ACTION APR 28
READING
4MIN
COSPONSORS
10BIPARTISAN
READER REACTIONS0 TOTAL
NO VOTES YET · BE THE FIRST
Introduced only
LEGISLATIVE PROGRESS
STEP 2 / 8
Introduced
In Committee
Reported
Passed Senate
Passed House
Conference
To President
Became Law
WHAT THE BILL DOES
AI-written
This bill matters because it addresses a significant financial barrier to breast cancer diagnosis and early detection. Currently, while preventive breast cancer screenings are often covered without cost-sharing under the Affordable Care Act, subsequent diagnostic or supplemental exams triggered by suspicious findings or high-risk factors typically require patients to pay deductibles, co-pays, or coinsurance. These costs can be substantial, leading some individuals to delay or forgo necessary follow-up care.
If this bill becomes law, it could lead to earlier diagnoses of breast cancer, as more people would be able to get recommended follow-up tests without financial hesitation. Earlier diagnosis generally leads to more effective treatment and better outcomes. If it doesn't pass, patients will continue to face out-of-pocket costs for these crucial diagnostic tests, potentially creating financial strain and hindering timely access to care, especially for those with lower incomes or high-deductible plans.
KEY PROVISIONS
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PROVISION 01
Prohibits health plans from charging deductibles, co-pays, or coinsurance for diagnostic and supplemental breast examinations.
Removes direct financial barriers for patients needing these crucial tests, encouraging timely follow-up.
PROVISION 02
Clarifies that health plans can still require prior authorization or other utilization controls for these examinations.
Allows insurers to manage the medical necessity and appropriateness of tests while removing cost-sharing.
PROVISION 03
Applies the no cost-sharing requirement to all group and individual health insurance coverage, including 'grandfathered' plans.
Ensures broad applicability of the benefit across various types of health plans.
PROVISION 04
Allows High Deductible Health Plans (HDHPs) to cover diagnostic and supplemental breast examinations without a deductible, preserving Health Savings Account (HSA) eligibility.
Ensures individuals with HDHPs, who often face high upfront costs, can access these exams without penalty.
This bill matters because it addresses a significant financial barrier to breast cancer diagnosis and early detection. Currently, while preventive breast cancer screenings are often covered without cost-sharing under the Affordable Care Act, subsequent diagnostic or supplemental exams triggered by suspicious findings or high-risk factors typically require patients to pay deductibles, co-pays, or coinsurance. These costs can be substantial, leading some individuals to delay or forgo necessary follow-up care.
If this bill becomes law, it could lead to earlier diagnoses of breast cancer, as more people would be able to get recommended follow-up tests without financial hesitation. Earlier diagnosis generally leads to more effective treatment and better outcomes. If it doesn't pass, patients will continue to face out-of-pocket costs for these crucial diagnostic tests, potentially creating financial strain and hindering timely access to care, especially for those with lower incomes or high-deductible plans.
KEY PROVISIONS
AI-extracted
high
Prohibits health plans from charging deductibles, co-pays, or coinsurance for diagnostic and supplemental breast examinations.
Removes direct financial barriers for patients needing these crucial tests, encouraging timely follow-up.
med
Clarifies that health plans can still require prior authorization or other utilization controls for these examinations.
Allows insurers to manage the medical necessity and appropriateness of tests while removing cost-sharing.
high
Applies the no cost-sharing requirement to all group and individual health insurance coverage, including 'grandfathered' plans.
Ensures broad applicability of the benefit across various types of health plans.
med
Allows High Deductible Health Plans (HDHPs) to cover diagnostic and supplemental breast examinations without a deductible, preserving Health Savings Account (HSA) eligibility.
Ensures individuals with HDHPs, who often face high upfront costs, can access these exams without penalty.
Amendments apply to plan years beginning on or after this date
GLOSSARY
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Cost-sharing requirements
The portion of a medical expense that a patient must pay out-of-pocket, such as a deductible (a fixed amount paid before insurance kicks in), coinsurance (a percentage of the cost), or a co-payment (a fixed fee).
Diagnostic breast examination
A breast exam (like a special mammogram, MRI, or ultrasound) performed when a screening exam shows something abnormal or a doctor finds a lump or other symptom, to determine if cancer is present.
Supplemental breast examination
A breast exam (like an MRI or ultrasound) performed to screen for breast cancer in individuals who are at a higher risk due to their personal or family medical history, even if no initial abnormality was found.
Group health plan
A health insurance plan offered to employees by an employer or to members by an organization, rather than purchased by individuals on their own.
Individual health insurance coverage
Health insurance purchased directly by an individual or family, not through an employer or a group plan.
Grandfathered health plan
A health plan that existed before the Affordable Care Act (ACA) was passed and has been continuously maintained without certain significant changes, allowing it to be exempt from some ACA requirements.
ACTION TIMELINE
2 EVENTS
APR 28, 25
Introduced in Senate
INTROREFERRAL
APR 28, 25
Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
A health insurance plan with a high deductible (the amount you must pay before your insurance starts to cover costs). These plans are often paired with a Health Savings Account (HSA).
Prior authorization
A requirement from your health insurance company that your doctor obtain approval before you can get a specific service, prescription, or procedure covered.
