​National Breast Screening Coverage
​What You Need to Know:
Federal guidelines, insurance rules, and evolving legislation shape breast cancer screening policies in the U.S.. Here's what you need to know to understand your rights, coverage, and options.​
Limitations:
While notification laws increase awareness, they don’t fix cost or access issues, leaving ongoing challenges for equitable and effective care.
Routine Mammogram Coverage
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Under the Affordable Care Act (ACA), most insurance plans—including Medicare and Medicaid—must cover routine mammograms starting at age 40, with no out-of-pocket costs.
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This includes women at average risk and follows USPSTF recommendations of mammograms every two years starting at age 40.
Dense Breast Notification Law
FDA 2023 MQSA Final Rule
Summary (2023/Effective September 2024)
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As of September 2024, all mammography providers must inform you if you have dense breast tissue.
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Dense breasts can make it harder to spot cancer on a mammogram.
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You are encouraged to talk with your healthcare provider about what this means for your screening plan.
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Note: Notification does not mean your insurance will cover extra tests like MRI or ultrasound.
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Supplemental Screening and Insurance Coverage
The U.S. Preventive Services Task Force (USPSTF) does not recommend routine supplemental screening—like MRIs or ultrasounds—for women with dense breasts or a 15–20% lifetime risk, due to insufficient evidence that it reduces deaths from breast cancer.
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Still, many experts support offering these tests based on individual risk factors.
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Because of the USPSTF guidelines, most insurance plans are not required to cover supplemental screenings, though routine mammograms are covered at no cost. Coverage for extra tests varies by state, plan, and insurance type.
Nationally: Advancing Policy for Better Screening Access
Find It Early Act: DenseBreast-info.org, in collaboration with its partners, is championing the Find It Early Act—a national initiative aimed at ensuring comprehensive breast cancer screening coverage for all women, regardless of breast density or risk factors.
The Access to Breast Cancer Diagnosis Act of 2025 (S-1500) is sponsored by key members of the U.S. Congress, aiming to improve access to essential breast cancer diagnostic tests (not supplemental screening). This bipartisan legislation is introduced in both the House and Senate, with support from lawmakers focused on removing financial barriers for patients by requiring insurance companies to cover these diagnostic screenings without cost-sharing. The goal is to ensure timely, affordable follow-up testing for women after initial mammograms, helping to catch breast cancer earlier and improve outcomes nationwide.
