Access to Breast Cancer Diagnosis Act of 2025

This bill amends the Public Health Service Act to require group health plans and health insurance issuers offering group or individual coverage to cover diagnostic and supplemental breast examinations without any cost-sharing, such as deductibles, coinsurance, or copayments. It also applies this requirement to grandfathered health plans and provides a safe harbor for high deductible health plans with health savings accounts, effective for plan years starting on or after January 1, 2026.

Sec. 2, Requiring diagnostic and supplemental breast examinations to be covered with no cost-sharing requirements: This section adds a new section 2730 to the Public Health Service Act. It prohibits group health plans and health insurance issuers from imposing any cost-sharing requirements (deductibles, coinsurance, copayments, or similar out-of-pocket expenses) for diagnostic and supplemental breast examinations. It clarifies that plans may still require prior authorization or other utilization controls, and does not supersede state laws that provide greater protections. Definitions are provided: a diagnostic breast examination is a medically necessary exam (following National Comprehensive Cancer Network Guidelines) used to evaluate an abnormality from a screening or other exam; a supplemental breast examination is a medically necessary screening exam for those with no abnormality but with increased risk due to personal or family history. The section also amends the Patient Protection and Affordable Care Act to apply this requirement to grandfathered health plans, and amends the Internal Revenue Code to allow high deductible health plans with health savings accounts to cover these exams without a deductible, for plan years beginning on or after January 1, 2026. The effective date is for plan years beginning on or after January 1, 2026.