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New Legislation Expands Insurance Coverage for Breast Cancer Screening and Imaging

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On the first day of Breast Cancer Awareness Month, Governor Kathy Hochul on Tuesday signed legislation to expand insurance coverage of breast cancer screening and imaging to include procedures as recommended by nationally recognized clinical practice guidelines for the detection of breast cancer.

“Every woman in New York State should have access to the full scope of coverage options for breast cancer screening and imaging, which is key to early diagnosis and treatment,” Governor Hochul said. “This legislation ensures that critical preventative services are available without financial constraint – saving lives and setting a new standard of care for New Yorkers.”

Legislation S.2465C/A.1696C changes parts of the Insurance Law to require individual, group, and non-profit (including HMO) health insurance plans to cover breast cancer screening and diagnostic imaging. This coverage applies if a doctor recommends it based on nationally recognized clinical guidelines. The screenings include diagnostic mammograms, breast ultrasounds, and MRIs.

The legislation also clarifies that cost-sharing will not apply to these procedures except to the extent it would result in health savings account ineligibility under IRS guidelines.

The legislation defines “nationally recognized clinical practice guidelines” to include evidence-based standards developed by independent organizations or medical professional societies using a transparent methodology and reporting structure.

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