Early Access to Screening Act

Summary#

This bill would change Medicare, Medicaid, and federal rules for group health plans so that annual screening mammography is covered with no cost sharing for women beginning at age 30. Key changes in the bill include:

  • Medicare (title XVIII): Adds rules effective January 1, 2026. The bill says Medicare cannot pay for screening mammography for a woman under 30. For women 30 and older, Medicare would not pay for a screening mammogram done sooner than 11 months after a prior screening (i.e., annual). For screening mammography performed on or after January 1, 2026, Medicare payment amounts are set to 100 percent of the lesser of the actual charge or the applicable Medicare fee schedule, which removes patient cost sharing for those services.

  • Medicaid (title XIX): Beginning January 1, 2026, the bill makes annual screening mammography for individuals over 29 a required covered service under Medicaid. It adds that such coverage may not impose deductions, cost sharing, or similar charges. The bill also adds annual screening mammography to the list of diagnostic, screening, preventive, and rehabilitative services in Medicaid law and applies these protections to alternative benefit plans.

  • Group health plans and individual market plans (Public Health Service Act, title XXVII): The bill amends coverage rules to require annual mammography screening for women over 29. These changes apply to plan years beginning on or after January 1, 2026.

The bill uses the term "woman" and refers to "women over 29," which the text treats as the group eligible for the age-30-and-older coverage.

What it means for you#

  • If you are a woman age 30 or older and have Medicare, Medicaid, or a group health plan covered by the federal rule, annual screening mammography would be covered without out-of-pocket cost starting January 1, 2026 (for private plans, the change applies to plan years starting on or after that date).
  • If you are under 30, the bill says Medicare payments are not allowed for screening mammography.
  • Medicaid alternative benefit plans must include annual screening mammography for people over 29 and may not charge cost sharing for it.

Expenses#

  • The bill specifies that for Medicare screening mammography performed on or after January 1, 2026, the amounts paid shall be 100 percent of the lesser of the actual charge or the Medicare fee schedule for those services.
  • No publicly available information on the overall federal, state, or private-sector budgetary effects or total costs is provided in the bill text or metadata.

Proponents' View#

No publicly available information.

Opponents' View#

No publicly available information.