February 24, 2017

No Unanimity for State Coverage Mandates

Some state laws require that women be informed about the availability of supplemental screening tests for breast cancer, such as ultrasound and MRI, but not all insurance plans cover the additional imaging tests. Depending on the insurance plan, patients may incur additional costs, such as copayments and deductibles, when follow-up screening tests are ordered by the referring physician. The following legislation is pending in several states to mandate additional coverage for supplemental screening tests:

Connecticut SB 810

Prohibit certain health insurance policies from imposing a copayment or deductible on mammograms and breast ultrasounds.

Massachusetts SD 702

Requires health insurers to cover three-dimensional screening mammography (tomosynthesis), ultrasound or MRI for breast cancer diagnoses without copayment or deductibles when an X-ray mammogram is unable to detect cancer due to insufficient breast tissue or dense breast tissue, as ordered by the patient’s physician.

New Jersey AB 2131

Amends P.L.1991, c.279 to require health insurers to cover a breast examination by MRI for women who are considered to be at high risk for breast cancer, if the MRI is recommended by the woman's physician. This coverage would be in addition to required coverage for mammograms and according to the same schedule as for a mammogram examination. The bill defines high risk for breast cancer to mean the woman has a family history of breast cancer or has as a background, ethnicity or coexisting medical condition or uses a medication that the physician believes puts her at elevated risk for breast cancer.

New York SB 1108

Provides health insurance coverage for a follow-up ultrasound for breast cancer screening upon the recommendation of a physician.

New York SB 1702

Relates to coverage for the detection of breast cancer, lowers the age of eligibility for an annual mammogram from 40 years old to 30 years old and requires coverage for follow-up treatment including biopsies.

We encourage you to link to Statescape – State Legislative Report to examine and understand to implications pending imaging-related and health care legislation in your state.