Zero-Dollar Breast Exams: New Bill Mandates Free Diagnostic Screenings Starting January 2026

If you’ve ever had a routine screening mammogram come back with a flag, you know the gut-punch of the follow-up bill. The screening might be covered 100%, but the diagnostic exam that clears the scare—or confirms the problem—often hits your deductible hard. The Access to Breast Cancer Diagnosis Act of 2025 is trying to eliminate that financial roadblock entirely.

The 'What': No More Cost-Sharing for Follow-Up Exams

Starting with plan years on or after January 1, 2026, this bill mandates that if your group or individual health insurance plan covers diagnostic or supplemental breast examinations, they must cover them with zero cost-sharing requirements (SEC. 2). That means no deductible, no copay, and no coinsurance for these specific tests. It’s a huge change because it targets the financial trap many people fall into after an abnormal screening.

To be clear, the bill defines two types of exams that must be covered for free:

1. Diagnostic Breast Examination: This is the follow-up. It’s needed when a screening or other test suggests something is wrong, and you need to figure out what it is.
2. Supplemental Breast Examination: This is for high-risk screening. If you have a strong family history or other risk factors, this is the extra screening your doctor orders even if nothing looks wrong yet.

Why This Matters for Your Wallet and Your Health

For most people, especially those with high-deductible health plans (HDHPs), this is a massive win for timely care. Right now, a diagnostic mammogram or ultrasound can cost hundreds or even thousands of dollars if you haven't met your deductible yet. That cost often causes people to delay or skip the crucial follow-up exam, turning a potential early catch into a much bigger problem later.

Under this Act, that financial hesitation is removed. If you’re a 40-year-old working professional whose annual screening flags a concern, you can immediately get the diagnostic work-up without worrying about whether you have $1,500 sitting in your FSA account. This applies even if you are covered by a “grandfathered” health plan—the older policies that were generally exempt from many ACA requirements (SEC. 2).

The Fine Print: What Insurers Can Still Do

While the bill eliminates the financial burden, it doesn't give patients a blank check for unlimited testing. Insurers can still require prior authorization or use other “appropriate controls” to manage the frequency of these exams (SEC. 2). This is a necessary reality check: it keeps insurance companies from footing the bill for unnecessary tests, but it also means patients might still face administrative hurdles. If the authorization process is slow or cumbersome, it could still delay care, even if the eventual exam is free.

Another important detail: the bill ensures that a plan won't lose its status as a High Deductible Health Plan (HDHP) just because it waives the deductible for these specific diagnostic and supplemental exams. This is key for people who rely on HDHPs and their associated Health Savings Accounts (HSAs); it ensures they can get necessary follow-up care without compromising their tax-advantaged savings structure.

Ultimately, this legislation is a clear move to prioritize early diagnosis by removing the most common barrier: the cost. It’s a straightforward, consumer-focused policy that directly impacts the health and financial stability of millions.