Follow-up mammograms and breast MRIs now free in Pennsylvania under new law

New law covers diagnostic tests after screenings

Pennsylvania just made follow-up breast imaging free for millions of women on state-regulated insurance plans. Gov. Josh Shapiro signed Senate Bill 88 into law on Nov. 24, 2025, as Act 52 of 2025.

The law requires insurers to cover diagnostic mammograms, breast ultrasounds, and breast MRIs with no copays, deductibles, or coinsurance.

The bill passed with strong bipartisan support, clearing the Senate 50-0 and the House 196-7.

Free screenings left a costly gap

Under the Affordable Care Act, routine screening mammograms are already free for women 40 and older.

But when a screening finds something abnormal, doctors order follow-up diagnostic tests, and those often come with big out-of-pocket bills. That’s the gap SB 88 closes.

Now insurers must cover the diagnostic mammograms, MRIs, and ultrasounds that come after an abnormal screening at no cost.

This is different from supplemental screenings for high-risk patients, which Pennsylvania already covered under a 2023 law.

Shapiro signed a similar law in 2023

Shapiro signed Act 1 in May 2023, which cut costs for supplemental breast screenings like MRIs and ultrasounds for high-risk patients.

That law also covered genetic testing and counseling for people with elevated risk factors like family history, genetic mutations, or dense breast tissue.

After Act 1 passed, 26 other states adopted similar supplemental screening laws.

But Pennsylvania was the only one of those states that still charged patients for diagnostic imaging. SB 88 fills that hole.

Average-risk patients now qualify too

Act 1 only helped people at high risk for breast cancer.

SB 88 expands coverage to average-risk patients who get an abnormal result on a routine screening mammogram.

That’s a big deal because most women who get called back for follow-up imaging are average-risk patients whose routine screening just showed something that needs a closer look.

The expansion lines up Pennsylvania’s law with federal guidance from the Health Resources and Services Administration.

Follow-up costs pushed women to skip tests

The financial burden of follow-up imaging has been well documented.

A Susan G. Komen study found that out-of-pocket costs average about $234 for a diagnostic mammogram and can top $1,000 for a breast MRI.

An American Cancer Society Cancer Action Network report from January 2025 estimated that more than 1 million women nationwide delayed follow-up testing in 2024 because of costs.

About 378,000 women skipped future screening mammograms altogether out of fear of what the follow-up might cost.

Personal stories drove the bill forward

Sen. Frank Farry, a Republican from Bucks County, was the primary sponsor. Farry has said his wife’s battle with breast cancer pushed him to act.

Senate President Pro Tempore Kim Ward, also a Republican, co-sponsored the bill. Ward is a breast cancer survivor who received her diagnosis in December 2020.

Rep. Gina Curry, a Democrat from Delaware County, led the effort in the House.

Both Farry and Curry received the PA Legislative Champion of 2025 Award from the American Cancer Society Cancer Action Network.

Advocacy groups and insurers backed it

Susan G. Komen, the American Cancer Society Cancer Action Network, and the PA Breast Cancer Coalition all supported the bill.

So did the Pennsylvania Radiological Society and the PA Section of the American College of Obstetricians and Gynecologists. The insurance industry did not oppose the law.

Supporters estimate the law could extend coverage to about 3 million Pennsylvanians with state-regulated insurance. That broad coalition helped the bill pass with near-unanimous votes in both chambers.

Self-funded employer plans are exempt

Not everyone benefits from the new law. State insurance mandates like SB 88 only apply to state-regulated plans, including individual, small group, and large group plans.

Self-funded employer plans fall under federal law and generally do not have to follow state mandates. A large share of American workers sit on self-funded plans, so many Pennsylvanians may not see any change.

Patients should check with their insurance provider or employer to find out whether their plan is state-regulated.

About 30 states have passed similar laws

Pennsylvania joins roughly 30 states that now eliminate out-of-pocket costs for diagnostic breast imaging.

In 2025 alone, seven more states enacted breast health measures: Arkansas, Colorado, Florida, Oklahoma, Texas, Utah, and Virginia.

The American College of Radiology has tracked more than 50 breast health bills across the country.

The wave of state action reflects growing awareness that the ACA’s free screening mammogram benefit leaves patients with big bills when follow-up is needed.

Congress considers a nationwide fix

While states pass their own laws, advocates also want a federal solution. The Access to Breast Cancer Diagnosis Act, or ABCD Act, was introduced in Congress in April 2025.

It would eliminate out-of-pocket costs for diagnostic and supplemental breast imaging nationwide. A federal law would reach patients in self-funded plans that state laws cannot touch.

A recent Komen survey found that about 90% of voters polled agree that health insurers should cover all recommended breast imaging.

Patients should check their coverage details

The law includes an onset window before coverage kicks in, so patients should call their insurer for the exact start date.

The law applies only to diagnostic imaging ordered after an abnormal screening, not to elective or unrelated imaging.

Pennsylvanians who believe their state-regulated plan is not following the law can contact the Pennsylvania Insurance Department.

For uninsured or underinsured women, the PA Department of Health’s Breast and Cervical Cancer Early Detection Program may cover screening and diagnostic costs.

Early detection saves lives in Pennsylvania

Breast cancer is the second leading cause of cancer death among women in the United States. In Pennsylvania, doctors diagnose more than 13,000 women with breast cancer each year.

Nearly 66% of breast cancer cases nationwide are caught before the cancer spreads, and early detection greatly improves survival.

Laws like SB 88 aim to remove the financial barriers that cause patients to delay the follow-up tests that make early detection possible. The law took effect after Shapiro signed it in November.

This article was created with AI assistance and human editing.

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