17/02/2025
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Pennsylvania, South Carolina propose requiring insurers to cover breast MRI, ultrasound
Marty Stempniak | February 09, 2025 | Radiology Business | Policy & Regulations
Lawmakers in Pennsylvania and South Carolina are proposing requiring health insurers to pay for breast MRI, ultrasound and other supplemental imaging.
Rep. Gina Curry and colleagues introduced House Bill 433 in the Keystone State Jan. 31, referring the measure to the Committee on Insurance. Rep. Sylleste Davis did the same with HB 3202 in South Carolina Jan. 14, as lawmakers sent the bill to the Committee on Labor, Commerce and Industry for consideration.
While health plans are required to cover regular screening mammograms, women with dense breasts or genetic a genetic predisposition to the disease may need additional exams. Gaps in coverage result in individuals paying anywhere from $234 for a follow-up diagnostic mammogram to over $1,000 for a breast MRI. These added costs lead to 1 in 5 women opting to forgo additional testing if they don’t have the funds, a study in Radiology found.
"Eliminating out-of-pocket costs for diagnostic breast imaging is not just a matter of healthcare—it's a matter of life and death,” Curry, a Democrat representing Pennsylvania’s Delaware County, said in a statement from the Susan G. Komen foundation shared Feb. 5. “By removing financial barriers to critical follow-up tests, we ensure no one has to choose between their health and their finances, ultimately saving lives and reducing long-term healthcare costs for all.”
Health plans were first required to cover regular screening mammograms under provisions of the Affordable Care Act. Some members of Congress have since pushed for national legislation to require necessary follow-up tests. However, unable to pass such a policy, states have enacted a patchwork of legislation. Over half now require insurers to cover supplemental imaging, with Massachusetts one of the most recent to pass legislation, signed by the governor in November. Others proposing breast imaging-related measures in 2025 include Utah and Virginia.
In Pennsylvania alone, over 13,650 will be diagnosed with the disease this year and 1,800 will die from the disease, Komen estimated. Another 5,870 will be diagnosed in South Carolina, and 790 are expected to perish from this form of cancer.
“Cost should not impact anyone’s chances to treat or survive cancer,” Rep. Davis said in a separate announcement. “However, the threat of these high costs keep women from getting the imaging they need. That’s why I am sponsoring HB 3202 to require health insurance providers to provide diagnostic and supplemental breast examination coverage without cost-sharing requirements.”
