Updated Federal Breast Screening Recommendations
NEWS: Breast Cancer Screening – Updated Federal Recommendations
On 12/30/24, the Health Resources and Services Administration (HRSA) issued a notice, Update to the Health Resources and Services Administration’s (HRSA) Women’s Preventative Service Guidelines. One of the Guideline revisions relates specifically to “Breast Cancer Screening for Women at Average Risk” and will take effect in January 2026 for applicable insurance plans*.
Some details:
- “Women may require additional imaging to complete the screening process or to address findings on the initial screening mammography. If additional imaging (e.g., magnetic resonance imaging (MRI), ultrasound, mammography) and pathology evaluation are indicated, these services also are recommended to complete the screening process for malignancies.”
- “While there are currently no randomized controlled trials to support separate recommendations for women with dense breasts, the updated clinical recommendation supports additional testing to complete initial screening, if needed, which may be more common for women with dense breasts”
- “Non-grandfathered group health plans and health insurance issuers offering group or individual health insurance coverage must cover without cost-sharing the services and screenings listed on the updated Women’s Preventive Services Guidelines for plan years (in the individual market, policy years) that begin 1 year after this date. Thus, for most plans, this update will take effect ….in 2026.”
*Clarification is pending on whether self-funded plans, federal plans (e.g., Medicare, VHA, TRICARE) and/or ERISA plans (a private sector retirement or health plan that’s governed by the Employee Retirement Income Security Act) are included. We will share more information as we learn it.