Insurance: health insurers; coverage for examinations and medications related to breast cancer; provide for. Amends sec. 3406d of 1956 PA 218 (MCL 500.3406d).

2025-2026 Regular Session Introduced by Joey Andrews and 31 co-sponsors

Requires insurers to cover a broad range of breast cancer services including diagnosis, treatment, rehabilitation, and screening with specific mammography rules.

bill electronically reproduced 11/04/2025

#insurance:healthinsurers

Summary — HB 5205 (2025): Insurance coverage for breast cancer services

Bill number: HB 5205
Introduced: March 14, 2025; electronically reproduced/introduced in the House on November 4, 2025
Sponsor: Rep. Matt Longjohn (and multiple co-sponsors)
Statute amended: 1956 PA 218, section 3406d (MCL 500.3406d)
Status (as of provided information): Read first time; referred to Committee on Insurance

Purpose / Intent

HB 5205 requires health insurers that deliver, issue for delivery, or renew health insurance policies in Michigan to offer or include coverage for a broad set of breast cancer–related services (diagnosis, outpatient treatment, rehabilitation, screening and certain supplemental exams). The measure updates and defines covered services and screening frequency.

Key provisions

Insurers must offer/include coverage for:

Breast cancer diagnostic services (e.g., mammography, surgical breast biopsy, pathology).
Breast cancer outpatient treatment services (e.g., surgery, radiation, chemotherapy, hormonal therapy, follow‑up).
Breast cancer rehabilitative services (e.g., reconstructive plastic surgery, physical therapy, psychological and social support).
Diagnostic breast examinations and supplemental breast examinations.

Screening mammography coverage:

Individuals 35–39 years: coverage for one screening mammography during that 5‑year period (text: “during that 5‑year period”).
Individuals 40 years and older: coverage for one screening mammography every calendar year.

Definitions:

Diagnostic and supplemental examinations are required to be “medically necessary and appropriate” in accordance with National Comprehensive Cancer Network (NCCN) Guidelines.
Supplemental breast examinations include MRI or ultrasound used to screen when no abnormality is seen but risk factors (e.g., personal/family history, heterogeneously or extremely dense breasts) increase cancer risk.

Cost-sharing language:

Subsections (1) and (2) begin with “Subject to dollar limits, deductibles, and coinsurance provisions that are not less favorable than those for physical illness generally.”
A later subsection (3) states: “Coverage under this section is not subject to dollar limits, deductibles, or copayments.” (Text contains a possible internal inconsistency regarding applicability of cost‑sharing.)

Who is affected

Health insurers issuing or renewing individual and group health insurance in Michigan.

Insured individuals seeking breast cancer screening, diagnosis, treatment, or rehabilitative services—particularly individuals aged 35 and older and those at elevated risk or with dense breasts.

Potential downstream effects on providers (radiology, oncology, surgery, rehabilitation) and insurer benefit design.

Procedural / timeline notes

Filed March 14, 2025; read and referred to committee multiple times; most recent reproduction/intro on Nov 4, 2025 and referred to the House Committee on Insurance.

If enacted, this amends an existing statutory provision (MCL 500.3406d) governing mandated breast cancer coverage.

Note: The bill’s conflicting statements on whether cost‑sharing applies may require legislative clarification or interpretation if enacted.