A new Mass. law requires insurance to cover breast cancer screenings. Here’s what to know.

Massachusetts Gov. Maura Healey signed a bill into law Monday that will ensure all breast cancer screenings are covered by insurance, increasing access across the state. 

Currently, only yearly mammograms are covered by insurance. In the U.S., about 10 to 12% of women are called back after a mammogram for more tests, and these additional diagnostic tools, which are not covered by insurance, can cost hundreds or thousands of dollars out of pocket. 

The legislation, An Act Relative to Medically Necessary Breast Screenings and Exams for Equity and Early Detection, will remove those costs and the barriers they bring with them. By 2026, according to a release, patients will have access to follow-up cancer screenings and exams with no out-of-pocket costs. Insurers will be required to cover diagnostic exams for breast cancer, digital breast tomosynthesis (DBT) screening, and breast MRIs and ultrasounds. 

By preventing patient cost-sharing from increasing, the legislation will ensure all patients who need more rigorous screenings have access to them, regardless of their financial situation. 

“This legislation will help ensure that cost is not a barrier for women to get the screenings and care they need,” Healey said in the release. 

Between 2016 and 2020, there were about 136 new cases of breast cancer for every 100,000 women in Massachusetts, slightly higher than the national average of 129 per 100,000 women, according to data from the Susan G. Komen Foundation. In 2024, the American Cancer Society estimates there will be 7,150 new cases of female breast cancer in Massachusetts, 730 of which will be fatal.

Susan G. Komen estimates the breast cancer mortality rate among women is 16 per 100,000 women, though rates increase as cancer progresses. Women diagnosed with stage 1, or localized breast cancer, have a 99% relative 5-year survival rate. But by the time it gets to stage 4, the 5-year survival rate is only 31%, meaning 69% will die within five years of their diagnosis, per the American Cancer Society. 

“Early detection of breast cancer saves lives,” said Sen. Joan Lovely (D-Salem), one of the petitioners of the bill, in the release. “This legislation makes those diagnostic exams used for early detection accessible and affordable, giving women the vital resources needed to catch breast cancer in its earliest stages.”

The bill received statements of support from Benjamin L. Ebert, MD, PhD, the president and CEO of the Dana-Farber Cancer Institute, as well as Meredith Mendelson, the executive director of the Ellie Fund, a Massachusetts non-profit that fights breast cancer and provides free services to cancer patients and families.

“We know that when health plans cover medically necessary screening and diagnostic breast imaging, we can detect breast cancer at an earlier stage which can make an enormous difference in outcomes,” Ebert said in a statement. 

Dana-Farber, which has been taking its mobile mammography van to underserved neighborhoods in Boston and surrounding communities to provide mammograms since 2002, has long been committed to increasing access to care for all. It was joined in advocating for the passage of this legislation by the MA Radiological Society, the American Cancer Society Cancer Action Network (ASC CAN), the Susan G. Komen Foundation, and Massachusetts hospitals and community health centers. 

Though initiatives like the mobile mammography van have made strides in getting women those initial screenings, the costs of follow-up tests, when necessary, often lead to delayed treatment, which impacts mortality. Although white and Black women are diagnosed with breast cancer at similar rates, the mortality rate is 40% higher for Black women, according to Dana-Farber. 

“Despite the fact that breast cancer death rates have been declining for several decades, not all people have benefited equally from the advances in prevention, early detection, and treatment that have helped achieve these lower rates,” Marc Hymovitz, Massachusetts director of government relations for the ASC CAN, said in a statement. “Eliminating cost barriers is a step towards addressing these inequities.”

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