Will diagnostic mammograms be free under the Access to Breast Cancer Diagnosis Act of 2025?

Yes. If a plan covers diagnostic breast exams, it cannot charge deductibles, copays, or coinsurance for them under the Access to Breast Cancer Diagnosis Act of 2025 (Section 2, new PHSA Sec. 2730(a)).

Does the bill make breast MRI and ultrasound free after an abnormal screening?

Yes. Diagnostic breast examinations include diagnostic mammography, breast MRI, and breast ultrasound when used to evaluate a suspected or detected abnormality, with no cost-sharing if covered (Section 2, Sec. 2730(a), (c)(2)).

Can health insurance charge a deductible for supplemental breast MRI for high-risk patients?

No. Supplemental breast examinations for high-risk patients cannot have deductibles, copays, coinsurance, or similar cost-sharing if the plan provides that benefit under the Access to Breast Cancer Diagnosis Act of 2025 (Section 2, Sec. 2730(a), (c)(1), (c)(3)).

When would no-cost diagnostic and supplemental breast exams start?

The requirement applies to plan years beginning on or after January 1, 2026, according to the Access to Breast Cancer Diagnosis Act of 2025 (Section 2(d)).

What counts as cost-sharing for breast diagnostic exams under this bill?

Cost-sharing includes deductibles, coinsurance, copayments, and any maximum limit on applying those expenses under the Access to Breast Cancer Diagnosis Act of 2025 (Section 2, Sec. 2730(c)(1)).

Does the bill apply to individual insurance plans as well as employer health plans?

Yes. It applies to group health plans and health insurance issuers offering both group and individual coverage under the Access to Breast Cancer Diagnosis Act of 2025 (Section 2, Sec. 2730(a)).

Can insurance still require prior authorization for diagnostic breast exams?

Yes. Plans may still require timely prior authorization and other appropriate utilization controls under the Access to Breast Cancer Diagnosis Act of 2025 (Section 2, Sec. 2730(b)(1)).

Do grandfathered health plans have to cover diagnostic breast exams with no cost-sharing?

Yes. The bill makes the new no-cost-sharing rule applicable to grandfathered health plans as well, according to the Access to Breast Cancer Diagnosis Act of 2025 (Section 2(b)).

Can an HSA-qualified high deductible health plan cover breast diagnostic exams before the deductible?

Yes. The bill creates an HDHP safe harbor so plans do not lose HSA eligibility for covering diagnostic and supplemental breast exams before the deductible (Section 2(c)).

Does the bill override state laws on breast imaging coverage?

No. It does not supersede state laws that provide greater protections than the federal standard under the Access to Breast Cancer Diagnosis Act of 2025 (Section 2, Sec. 2730(b)(2)).

H.R. 3037: Closing the Meal Gap Act of 2023

Introduced May 2, 202330 cosponsors

Sponsor

Alma Adams

Democrat · NC

Bill Progress

IntroducedMay 2

Committee

Pass House

Pass Senate

Signed

Law

Latest Action · May 2, 2023

1/3

Assigned to Subcommittee on Nutrition, Foreign Agriculture, and Horticulture. for review

HR3037 Legislative Journey

1 actions

Committee Action

May 2, 2023

Referred to the Subcommittee on Nutrition, Foreign Agriculture, and Horticulture.

About the Sponsor

Alma Adams

Democrat, North Carolina's 12th congressional district · 12 years in Congress

Committees: Agriculture, Education and Workforce

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Cosponsors (30)

No new cosponsors in 74 days — momentum stalled

This bill has 30 cosponsors: 23 Democrats, 7 Republicans, reflecting bipartisan support. Cosponsors represent 18 states: California, Colorado, Connecticut, and 15 more.

23Democrats7Republicans·18 statesBipartisan

Brian Fitzpatrick

Republican · PA

Debbie Wasserman Schultz

Democrat · FL

Lloyd Doggett

Democrat · TX

Gwen Moore

Democrat · WI

Eleanor Norton

Democrat · DC

Melanie Stansbury

Democrat · NM

Seth Moulton

Democrat · MA

Jahana Hayes

Democrat · CT

Timothy Kennedy

Democrat · NY

John Larson

Democrat · CT

Paul Tonko

Democrat · NY

Yvette Clarke

Democrat · NY

H.R. 3037 Quick Facts

Cosponsors

+25 more

Chamber: House
Policy: Agriculture and Food
Introduced: May 2, 2023

Assigned to Subcommittee on Nutrition, Foreign Agriculture, and Horticulture. for review

May 2, 2023

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H.R. 3037 Bill Text

“To amend title XXVII of the Public Health Service Act to prohibit group health plans and health insurance issuers offering group or individual health insurance coverage from imposing cost-sharing requirements with respect to diagnostic and supplemental breast examinations.”

Source: U.S. Government Publishing Office

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