Under the Affordable Care Act, 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.

Beginning January 1, 2024, for health plans that include coverage of supplemental breast examinations and diagnostic breast examinations, health carriers may not impose cost sharing for such examinations. 

"Diagnostic breast examination" means a medically necessary and appropriate examination, including an examination using diagnostic mammography, breast magnetic resonance imaging, or ultrasound, that is used to evaluate an abnormality seen or suspected from a screening examination for breast cancer, or detected by another means of examination.

"Supplemental breast examination" means a medically necessary and appropriate examination, including an examination using breast magnetic resonance imaging or ultrasound, that is used to screen for breast cancer based an individual's personal or family medical history, or additional factors that may increase the individual's risk of breast cancer.

PRO: Additional screening is often needed after a mammogram to determine if an abnormality is cancerous and to evaluate treatment options. Patient out-of-pocket costs can be high for supplemental screenings, and delaying care because of cost can result in worse health outcomes.

CON: The federal government is currently evaluating supplemental screening options. The state should wait for the federal review to be completed as well as further evaluate the fiscal impact to the state.