Women: Check Mammography Coverage Before Choosing Health Plan

January 20, 2010

older woman with female doctor taking a look at xray

*Updated September 24, 2025

Whether you’re male or female, choosing between HMO and PPO health plans can be difficult. For women, however, it’s especially important to take a close look at covered preventive services before selecting a plan. What’s a preventive service? It includes things like a screening mammogram, which has long been considered routine wellness care for women beginning at age 40.

Late last year, however, the U.S. Preventive Services Task Force (USPSTF) issued new guidance on breast cancer screening. They declared that regular mammograms may not be as helpful for women under the age of 50 who are at average risk for breast cancer. In November 2009, they announced that the test does not need to be routinely recommended for non-high-risk women (with no family history of breast cancer) between ages 40–49. For women aged 50 to 74, biennial screening mammography (every two years) is now recommended, instead of annually.

Of course, if a woman wants annual mammograms for women 40 and older, she can and should still request them—especially if she has a history of breast cancer or a higher risk of breast cancer. Early detection continues to be critical in lowering breast cancer mortality and improving cancer treatment outcomes.

Medicare Coverage of Breast Cancer Screening

In terms of changes to health insurance coverage, there’s very little risk that your existing plan will drop coverage of breast screening or deny a mammogram if your health care provider recommends it. Medicare Part B and most insurance plans are required to cover screening mammograms as a preventive service, often with no out-of-pocket costs. Women enrolled in Medicare Advantage plans should also review their plan details, as Medicare covers both screening mammography and diagnostic mammogram services under certain conditions.

If you’re shopping for a new insurance plan, be sure to carefully review the coverage determinations for screening and preventive services. Look at exactly when and how often mammography screening is included and whether additional procedures like digital breast tomosynthesis or breast MRI may be covered if you’re at higher risk.

Breast Cancer Screening in the United States

While all 50 states mandate some kind of mammography coverage, the details of mandatory preventive services vary from state to state. For example, the Affordable Care Act requires most insurance plans to cover breast cancer screening beginning at age 40 without cost-sharing. At the federal level, programs like the National Breast and Cervical Cancer Early Detection Program provide free or low-cost mammograms for qualifying women.

In the United States, breast cancer is the second leading cause of cancer death among women. It is recommended that women get screened for breast cancer regularly to reduce their risk of cancer going undetected. The American Cancer Society and the United States Preventive Services Task Force continue to refine recommendations based on the benefits and harms of screening mammography.

Key Takeaways

  • Mammograms may be recommended biennially for women ages 40 to 74 at average risk, but some women may still benefit from annual mammograms.

  • Medicare coverage and most insurance plans are required to cover screening mammograms, reducing or eliminating out-of-pocket costs.

  • Women with a family history of breast cancer, those previously diagnosed with breast cancer, or those with other risk factors should talk to their primary care provider about screening tests like diagnostic mammograms or breast MRI.

  • Programs like the National Breast and Cervical Cancer Early Detection Program help ensure access to regular mammograms for underserved populations.

You can check specific state mandates and local coverage details at the Council for Affordable Health Insurance or through your plan administrator. Don’t wait—if you’re 40 and older, talk to your doctor and get a mammogram. Regular breast cancer screening remains one of the most effective tools for early detection and improving survival rates in cases of breast cancer.