No More Copays for Breast Cancer Diagnostics: New Law Mandates Zero Cost-Sharing Starting 2026

If you’ve ever had a routine mammogram flag something suspicious, you know the immediate anxiety. That anxiety is often compounded by the dread of the follow-up bill for the diagnostic imaging—the ultrasound, the diagnostic mammogram, or even the biopsy. These necessary diagnostic tests often come with hefty deductibles or copays, creating a financial barrier to finding out if you have cancer.

The Access to Breast Cancer Diagnosis Act of 2025 aims to eliminate that specific financial hurdle. Starting with plan years beginning on or after January 1, 2026, if your group health plan or insurance company already covers diagnostic or supplemental breast exams, they must cover them with zero cost-sharing. This means no deductible, no copayment, and no coinsurance for you. Furthermore, the cost of these exams won't count toward your annual out-of-pocket maximum.

The Fine Print: What’s Covered for Free?

This isn't about routine screening mammograms—those are already covered for free under existing law. This bill focuses on the crucial next steps. The law defines two specific types of exams that must be covered without cost-sharing:

1. Diagnostic Breast Examination: This is the follow-up test ordered by your doctor when they find an abnormality during a screening or suspect an issue. It’s the test used to figure out what is actually going on.
2. Supplemental Breast Examination: This is an extra screening (like a breast MRI or ultrasound) for people who don't have a known abnormality but are considered high-risk due to family history, genetics, or other factors. These are proactive tests for those who need more than just an annual mammogram.

For someone managing a small business or working a demanding job, this is a huge deal. Imagine a technician who finds a lump and needs an immediate diagnostic ultrasound. Under current rules, that $800 ultrasound might hit their $2,000 deductible. Under this new rule, if the plan covers it, the patient pays $0. This removes the incentive to delay crucial testing out of fear of the bill, which is exactly what policy analysts call reducing 'financial toxicity' in health care.

Protecting High Deductible Plans (and Your Wallet)

One of the smarter provisions in this bill addresses how these new rules interact with High Deductible Health Plans (HDHPs)—the plans often paired with Health Savings Accounts (HSAs). HDHPs usually require you to meet a high deductible before insurance pays for anything (except preventative care). If the law forced these diagnostic tests to be covered before the deductible, those plans would lose their HDHP status, which would be a massive headache for millions of people who rely on HSAs.

The bill cleverly fixes this, stating that starting in 2026, a plan will not lose its HDHP status just because it covers these diagnostic and supplemental breast exams without a deductible. This protects the integrity of HSAs while ensuring patients get the care they need immediately.

The Catch: Prior Authorization Remains

While the financial barrier is gone, the bureaucratic one remains. The bill specifically states that insurance plans are still allowed to require prior authorization before covering these exams. Prior authorization is the process where your doctor has to get permission from the insurance company before ordering a test or procedure.

For patients, this means that even though the test is free, the plan can still slow down the process. An insurer could potentially use strict prior authorization rules to manage costs, which could lead to delays in diagnosis. While the intent of the bill is to increase access, the retention of prior authorization means that timely access might still be a challenge, especially if insurers decide to push back hard on approving these newly mandated no-cost services.