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Big changes are coming to women’s preventive care coverage! Starting with plan years on or after December 31, 2025, group health plans and health insurance issuers must expand their no-cost coverage for women’s preventive care. This expansion includes additional breast cancer imaging or testing needed to complete an initial mammogram, as well as patient navigation services for breast and cervical cancer screenings.
These updates fall under the Affordable Care Act’s (ACA) preventive care mandate, which requires most health plans to cover a range of preventive services without deductibles, copayments, or coinsurance when using in-network providers. The ACA’s guidelines are regularly updated.
The latest HRSA-supported guidelines, updated on December 30, 2024, specifically expand breast cancer screening to include necessary follow-up imaging (such as MRIs or ultrasounds) or pathology evaluations beyond the initial mammogram. Additionally, starting in 2026, patient navigation services for breast and cervical cancer screening and follow-up will be covered. These services offer personalized support, help with healthcare access, referrals to essential services (like language translation or transportation), and patient education.