Under the Affordable Care Act (ACA), health benefit plans must provide, at a minimum, coverage with no cost sharing, for preventive or wellness services that have a rating of A or B in the current recommendations of the United States Preventive Services Task Force (USPSTF).  The USPSTF recommends, at a B grade, screening mammography, with or without clinical breast examination, every one to two years for women age 40 years and older.  The USPSTF also recommends, at a B grade, genetic counseling and testing for mutation of the BRCA1 and BRCA2 genes in women with a personal or family history of breast, ovarian, fallopian tube, or peritoneal cancer, or an ancestry associated with BRCA1 or 2 gene mutation and preventive medication for women 35 years old or older with elevated risk of breast cancer and at low risk for adverse medication effects.

The American Cancer Society currently identifies women at high risk of developing breast cancer as those who:

• have a lifetime risk of breast cancer of about 20 percent to 25 percent or greater, according to risk assessment tools that are based mainly on family history;
• have a known BRCA1 or BRCA2 gene mutation;
• have a first-degree relative—parent, brother, sister, or child—with a BRCA1 or BRCA2 gene mutation, and have not had genetic testing themselves;
• had radiation therapy to the chest when they were between the ages of 10 and 30 years; or
• have Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or have first-degree relatives with one of these syndromes.

For large group health plans issued or renewed on or after January 1, 2023, a health carrier shall provide coverage without cost sharing for supplemental magnetic resonance imaging breast cancer screening for women at high risk of developing breast cancer as an adjunct to mammography consistent with clinical guidelines, criteria, or treatment recommendations adopted by the American Cancer Society.