Find It Early Act: High-Risk Breast Screenings Get Zero Co-Pay Coverage Starting 2026

The “Find It Early Act” is straightforward: it mandates that starting January 1, 2026, most health plans must cover advanced breast cancer screenings with absolutely no out-of-pocket costs for individuals determined to be at higher risk. This isn’t just about standard mammograms; the bill specifically targets more complex and often more expensive tools like breast ultrasounds, MRIs, and molecular breast imaging. The key takeaway is the removal of cost-sharing—meaning no co-pays, no deductibles, and no co-insurance for those who need these extra checks. This requirement applies across the board, hitting private insurance (even grandfathered plans), Medicare, Medicaid, TRICARE, and the VA healthcare system (Sec. 2).

The Fine Print on Who’s Covered

So, who qualifies for this zero-dollar screening? The bill focuses on two main groups. First, it covers people who are already known to be at increased risk of breast cancer or those who have heterogeneously or extremely dense breast tissue. If you’ve ever had that follow-up letter after a mammogram saying you have dense breasts, this provision is aimed directly at you, as dense tissue can hide small tumors and often requires supplementary imaging. The second group is a bit broader: anyone a healthcare provider determines needs the screening due to factors like age, race, ethnicity, or personal/family medical history. This gives doctors the flexibility to order the necessary follow-up tests without having to worry that a massive bill will hit the patient later. All screenings must follow the frequency recommended by the National Comprehensive Cancer Network (NCCN) guidelines, ensuring the coverage is based on the latest medical evidence (Sec. 2).

The Real-World Impact: Removing the Financial Wall

For most people, the biggest barrier to follow-up testing isn’t the test itself—it’s the cost. A standard mammogram might be covered, but when the doctor orders a breast MRI or a targeted ultrasound because of dense tissue or a concerning family history, that bill can easily run into the thousands, often hitting the patient’s deductible first. This bill essentially eliminates that financial wall for high-risk individuals. Think of a 35-year-old with a strong family history of breast cancer who currently pays a $500 co-pay for an annual screening MRI; come 2026, that charge should be zero. This shift is expected to significantly increase early detection rates, which is crucial for better outcomes. It also standardizes coverage across federal programs, so whether you’re a veteran, on Medicaid, or covered by a large employer plan, the rules should be the same.

The Implementation Challenge: Who Pays the Tab?

While this is great news for patients, it does introduce some significant new costs into the system. Insurance providers, Medicare, and state Medicaid programs will now be footing the bill for these advanced, no-cost screenings. For states, this means mandatory increased spending on Medicaid, which could strain budgets, even though the federal government usually covers a large share. For private plans, this is a new mandated benefit, which could put upward pressure on premiums across the board to offset the increased utilization. There’s also the potential for some vagueness in the second coverage group—the one based on provider determination. While clinical judgment is necessary, without clear thresholds, there might be initial inconsistencies in how often these advanced, expensive screenings are ordered until the new guidelines are firmly established and providers are trained on the new rules.