New Legislation Roundup: Changes To Healthcare And Insurance In 2025

Jan 13

The start of 2025 ushered in new legislative updates in the state of Illinois, and The Insurance People are here to keep you in the know! These laws will expand and define coverage of specific healthcare necessities as outlined below. Read on to learn about these changes to utilize your health insurance plan accordingly.

Colonoscopy coverage. Medically necessary colonoscopies must be covered by group and individual plans as of January 1, 2026.
Epinephrine cost limit. Medically necessary twin-packs of epinephrine injectors may not exceed $60 for insured people as of January 1, 2025.
Diagnostic mammogram screenings. Molecular breast imaging (MBI) will be covered if a mammogram demonstrates heterogeneous or dense breast tissue as determined by a physician. Mammograms, mastectomies, and other breast screenings will be covered as of January 1, 2026.
Dependent parent coverage. Parents or stepparents of insured people may be covered if they meet the federal qualifications or live in the insured’s service area as of January 1, 2025.
Miscarriage/stillbirth. Coverage for medically necessary treatment of mental, emotional, nervous, or substance use disorder for individuals who have experienced miscarriage or stillbirth is required to be covered at equal cost-sharing as any other treatment under their plan as of January 1, 2026.
Hormone therapy - Menopause. Hormone therapy treatment will be covered for menopause, and not just for individuals who have had hysterectomies as of January 1, 2026.
Pregnancy tests. Coverage is provided for urine-based, at-home pregnancy tests when prescribed by a physician, even if over-the-counter options are available as of January 1, 2025.
Prosthetic device coverage. Regardless of age, medically necessary, prosthetic devices that enhance whole body health and activity that are determined to be the best-use model for the insured receive coverage benefits as of January 1, 2025.
Generic drug shortage. If the supply of a generic drug becomes unavailable, insurance companies will cover brand name replacement until generic supply is available as of January 1, 2025.
Cancer - Genetic testing. Coverage will be provided for clinical genetic testing for individuals with personal or family history of inherited genetic mutations as advised by a physician as of January 1, 2025.
Electronic payment fees. All reasonably available methods of payment shall be offered and accepted by insurance companies, and credit card payments cannot be mandated. Insurers will notify insured people of associated fees as of January 1, 2025.
Dental loss ratio act. Equal coverage for medically necessary care and treatment to address a jaw injury as a result of disease or injury is required as of January 1, 2025.
Mobile integrated health. Coverage for medically necessary mobile integrated healthcare services is required as of January 1, 2025.