Privacy, Policy & Legal Issues > Laws & Protections > ACA > Screening & Preventive Services

Mammograms for women ages 40 and olderWoman in a hospital gown about to get a mammogram

The Patient Protection and Affordable Care Act (ACA) focuses on the screening and preventive needs of Americans at average risk of cancer and other diseases. It requires most health insurers to pay for screening mammograms with no out-of-pocket expenses for women ages 40 and older. The law does not apply to women below the age of 40, and it covers only one screening test per year, at most.

For high-risk women, health insurers usually cover mammograms for women under the age of 40, and other screenings such as breast ultrasound or breast MRI as recommended by expert medical guidelines but they are not required to cover these services at 100% so insurance deductibles, coinsurance and copays often apply.

Note that the ACA does not apply to Medicare or Medicaid. They have their own rules. See the Insurance & Paying for Care section of our website to learn more.

paying-for-service

  • Problems with insurance coverage of mammograms or other recommended screening and preventive services? Visit our section on Insurance & Paying for Care for guidance.