Starting with health plans issued or renewed on or after January 1, 2027, the state-regulated insurers named in this law may not charge deductibles, copays or coinsurance for screening mammograms or for diagnostic and supplemental breast exams needed to complete screening, with a narrower rule for high deductible plans.
Official title: insurance; cost sharing; breast exams
- September 12, 2026
- January 1, 2027: Cost-sharing ban applies to contracts, evidences of coverage and policies issued, amended, delivered or renewed on or after this date
What changes
-
NowHospital and medical service corporations, health care services organizations and disability insurers (individual, group or blanket) that issue, amend, deliver or renew coverage on or after January 1, 2027 may not impose cost sharing for screening mammography.
-
NowThe same insurers also may not impose cost sharing for 'additional screening services required to complete the screening continuum,' which include diagnostic and supplemental breast exams.
-
NowA diagnostic breast exam is a medically necessary exam that follows National Comprehensive Cancer Network guidelines and uses contrast enhanced mammography, diagnostic mammography, breast MRI, breast ultrasound or molecular breast imaging to check an abnormality found by a screening or another exam.
-
NowA supplemental breast exam is a medically necessary exam using contrast enhanced mammography, breast MRI, breast ultrasound or molecular breast imaging to screen when no abnormality is seen or suspected, based on personal or family history or other risk factors, including heterogenous or extremely dense breasts.
-
NowFor high deductible health plans as defined in federal tax law, the no-cost-sharing rule applies only after the deductible is met, except that items or services counted as preventive under federal law are covered without cost sharing even before the deductible is met.
Who it affects
- People with health coverage from state-regulated hospital or medical service corporations, health care services organizations or disability insurers
- People enrolled in high deductible health plans from these insurers
- Hospital service corporations and medical service corporations
- Health care services organizations
- Disability insurers, including group and blanket disability insurers
What you need to do
Nothing.
What the law doesn't answer
- Whether this applies to self-funded employer plans, AHCCCS (Medicaid), Medicare or other plans not regulated by these insurance laws
- What exactly counts as 'required to complete the screening continuum'
- Whether there are limits on how often the no-cost exams can be received
- Whether the rule applies to out-of-network providers
- How the rule will be enforced or what penalties apply to insurers that do not comply
- Whether premiums may change as a result
This summary describes the law as enacted. Later laws, court rulings or referendum petitions can change the picture. Check the official text for the current wording.