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Bill

MD

Bill

A 5542

Requires health insurance coverage of diagnostic and supplemental breast examinations without cost-sharing.

2024-2025 Regular Session Introduced by Margie Donlon and 3 co-sponsors

New Jersey bill eliminates patient cost-sharing for diagnostic and supplemental breast imaging to increase access to cancer detection tools, raising insurance costs.

Introduced in the Assembly, Referred to Assembly Financial Institutions and Insurance Committee
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Bill Summary · A 5542

Legislative bill overview

A5542 mandates that health insurance plans in New Jersey cover diagnostic and supplemental breast examinations (such as ultrasounds and MRIs) with no patient cost-sharing—meaning no copays, coinsurance, or deductibles. The bill applies to all health insurance carriers operating in the state and aims to remove financial barriers to these additional screening tools beyond standard mammography.

Why is this important

Diagnostic and supplemental breast exams can detect cancers missed by mammography alone, particularly in patients with dense breast tissue. Eliminating cost-sharing could increase utilization of these potentially life-saving tools and reduce financial hardship for patients requiring follow-up imaging. However, broader insurance coverage without cost-sharing typically increases premiums or reduces insurer margins, affecting overall healthcare costs.

Potential points of contention

  • Cost allocation: Removing cost-sharing increases insurer costs, which may be passed to employers and employees through higher premiums or reduced benefits elsewhere
  • Medical necessity criteria: The bill doesn't specify whether these exams require physician referral or can be self-ordered, potentially affecting appropriate utilization and costs
  • Scope ambiguity: "Supplemental" exams may be interpreted broadly, creating uncertainty about which imaging modalities and frequency are covered without limitations

Compiled from official sources — confirm details with the bill’s official record.

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