H.R. 3037: Access to Breast Cancer Diagnosis Act of 2025

HR3037, the Access to Breast Cancer Diagnosis Act of 2025, would require group health plans and health insurance issuers in both the group and individual markets to cover diagnostic and supplemental breast examinations without cost-sharing. The bill is explicit about what insurers cannot charge: no deductible, no coinsurance, no copayment, and no maximum limitation tied to those out-of-pocket costs. Those protections would apply for plan years beginning on or after January 1, 2026, and they would also apply to grandfathered health plans under the Affordable Care Act.

The bill draws a clear line between two types of breast exams. A "diagnostic breast examination" is a medically necessary and appropriate exam, consistent with National Comprehensive Cancer Network Guidelines, used to evaluate an abnormality seen or suspected from a breast cancer screening exam or detected by another method. The fact sheet specifically lists diagnostic mammography, breast magnetic resonance imaging, and breast ultrasound as examples. A "supplemental breast examination" is also medically necessary and appropriate under those same guidelines, but it is used when there is no abnormality seen or suspected and the exam is provided because a person’s personal or family medical history, or other factors, raise breast cancer risk.

The measure does not eliminate insurer management tools entirely. Plans and issuers would still be allowed to require timely prior authorization and impose other appropriate utilization controls. That means patients may still face administrative hurdles even if they no longer face copays or deductibles. At the same time, the bill preserves stronger State laws by saying it does not supersede State protections that provide greater coverage for these exams.

A practical issue the bill addresses is high-deductible health plan treatment. For plan years beginning on or after January 1, 2026, a high deductible health plan would not lose its HDHP status under Section 223(c)(2) of the Internal Revenue Code just because it covers diagnostic and supplemental breast examinations before the deductible is met. That safe harbor matters for people who pair HDHP coverage with health savings accounts, because it lets plans comply with the new no-cost-sharing rule without jeopardizing HSA eligibility.