HR6182-119

What This Bill Does

The Find It Early Act creates no-cost coverage rules for additional breast cancer screening and diagnostic imaging across the Public Health Service Act, ERISA group health plans, the Internal Revenue Code group health plan rules, and Veterans Affairs care. For plan years beginning on or after January 1, 2026, group health plans and health insurance issuers offering group or individual coverage must cover, without cost-sharing, screening and diagnostic imaging for individuals at increased risk of breast cancer under American College of Radiology or National Comprehensive Cancer Network criteria, or with heterogeneously or extremely dense breast tissue under the American College of Radiology BI-RADS system. Covered imaging includes 2D or 3D mammograms, breast ultrasounds, breast MRI, molecular breast imaging, contrast-enhanced mammography, and other technologies supported by applicable criteria or guidelines, at NCCN-recommended frequency. The bill also covers individuals not in that high-risk or dense-breast category when a provider determines screening or diagnostic breast imaging is needed due to factors such as age, race, ethnicity, or personal or family medical history. Parallel ERISA and tax-code provisions apply the same rule to group health plans. VA must furnish the same screening and diagnostic imaging to qualifying veterans regardless of whether they are enrolled in the annual VA patient enrollment system.

Who Benefits and How

Patients with dense breast tissue benefit because supplemental imaging must be covered without cost-sharing when ACR or NCCN criteria support it. Patients at increased breast cancer risk benefit because mammograms, ultrasound, MRI, molecular breast imaging, and contrast-enhanced mammography are covered at guideline-recommended frequency. Patients whose providers identify risk based on age, race, ethnicity, or medical history benefit because they can receive covered diagnostic breast imaging even if they do not meet the first category. Veterans at increased risk of breast cancer benefit because VA must furnish covered imaging without regard to annual enrollment status. Breast imaging providers benefit from expanded coverage for supplemental and diagnostic breast imaging technologies.

Who Bears the Burden and How

Health insurance issuers must cover required breast screening and diagnostic imaging without patient cost-sharing in group and individual markets. Group health plans must update benefit designs under PHSA, ERISA, and tax-code rules for plan years beginning January 1, 2026. Employer plan sponsors may face higher plan costs from no-cost supplemental breast imaging coverage. Veterans Affairs medical facilities must furnish the required breast imaging to qualifying veterans regardless of enrollment status. Plan administrators must apply ACR, NCCN, BI-RADS, provider-determination, and technology-coverage rules when processing claims.

Key Provisions

• Requires group and individual health insurance coverage of additional breast cancer screening and diagnostic imaging without cost-sharing.
• Requires no-cost coverage for individuals at increased breast cancer risk under ACR or NCCN criteria.
• Requires no-cost coverage for individuals with heterogeneously or extremely dense breast tissue under BI-RADS definitions.
• Requires no-cost coverage when a provider determines screening or diagnostic imaging is needed based on age, race, ethnicity, or medical history.
• Applies parallel requirements to ERISA group health plans and tax-code group health plan rules.
• Requires Veterans Affairs to furnish qualifying breast screening and diagnostic imaging regardless of annual enrollment status.