California Breast Screening Policies
Under federal regulations, including the Affordable Care Act, insurers — such as Medicare and Medicaid — are required to cover annual screening mammograms for women aged 40 and older. Mammogram providers must also inform women about their breast density.
However, California does not have additional legislation requiring coverage of medically necessary diagnostic or supplemental breast imaging. As a result, coverage for supplemental screening tests may vary depending on the insurance plan, especially for Medicare, Medicaid, military, or self-insured plans.
California SB974/AB 2024
SB 974/AB 2024: This bill, also under consideration, would have prohibited cost-sharing for medically necessary breast imaging, including (1) diagnostic or (2) primary screening for those not known to be at higher risk, or (3) supplemental screening for those at high risk for breast cancer. (Vetoed 2022)
California SB257
SB257: This bill would have required health plans to provide coverage without cost-sharing for screening mammography, medically necessary diagnostic or supplemental breast examinations, diagnostic mammography, testing for screening or diagnostic purposes, and medically necessary diagnostic breast imaging. (Vetoed 2023)
