The Price of Early Detection: Why Insurance Reform Is the Next Step in Breast Cancer Care

Public health campaigns have done their job: more women are getting screened for breast cancer than ever before. But what happens when the mammogram finds something suspicious and the next test comes with a bill?

Across the country, many women are discovering that while screening mammograms are covered in full, diagnostic or follow-up imaging often is not. That single distinction between screening and diagnostic creates a financial barrier that delays care and, in some cases, costs lives.

The Coverage Gap

Under the Affordable Care Act, screening mammograms are fully covered without copay or deductible. However, when a radiologist recommends additional imaging after finding an area of concern, that next test is coded as diagnostic. From that moment, most insurance plans treat it like any other medical service that is subject to deductibles and coinsurance.

A 2025 report by the American Cancer Society Cancer Action Network (ACS CAN) revealed how widespread the problem has become. The study found that 70.4 percent of insured women paid out-of-pocket for follow-up diagnostic breast imaging in 2023. About 1.1 million women are expected to delay or skip medically necessary tests this year because of cost concerns. Nearly 378,000 more are likely to avoid future mammograms for fear of unexpected bills. According to ACS CAN, removing cost-sharing for diagnostic imaging could prevent more than 7,500 late-stage breast cancer diagnoses and save about 2.2 billion dollars in treatment costs across the United States.

These numbers make it clear that financial barriers are not abstract. They have real effects on who gets diagnosed and how early that diagnosis happens.

When Cost Stops Care

Breast imaging specialists across the country report seeing patients postpone diagnostic testing because of unexpected costs.

In an interview, radiologist Dr. Amy Patel, Medical Director of Breast Imaging at Liberty Hospital and past Chair of the ACR Radiology Advocacy Network, described how younger women sometimes delay care after abnormal screenings.

“Those are essentially the patient stories that stick with me,” she said, “when they’re younger and can’t afford the cost of a diagnostic mammogram and possible ultrasound.”

Even short delays matter. A small, localized tumor can progress in a matter of months, turning a treatable condition into an advanced-stage disease that demands aggressive therapy.

State Reforms: Closing the Gap Locally

Because the ACA mandates free screening but not diagnostic imaging, several states have stepped in to close that gap through legislation.

Missouri has been among the leaders. Its Senate Bill 106, effective January 1, 2024, requires insurers to cover both diagnostic and supplemental breast imaging, such as MRI or ultrasound, without copays or deductibles. The statute (Missouri Revised Statute § 376.1183) defines these terms clearly and prohibits cost-sharing for either exam type states have enacted similar reforms.

Arkansas passed Act 268 (HB 1309), mandating no-cost coverage for diagnostic and supplemental breast exams, including MRI and ultrasound. Colorado’s SB 25-296 ensures full coverage of medically necessary diagnostic and supplemental breast imaging without cost-sharing . New York requires insurers to cover both screening and diagnostic breast imaging at no cost under state law. Virginia enacted legislation in 2024 that will ban cost-sharing for diagnostic and supplemental imaging, taking effect January 1, 2026. Illinois provides partial protections, covering physician-ordered ultrasounds for dense-breasted women, but does not yet eliminate cost-sharing for all diagnostic imaging services .

As a result, access remains inconsistent. A woman in Missouri or New York may receive follow-up imaging free of charge, while a woman in a neighboring state might still pay hundreds or even thousands of dollars for the same test.

Why It Matters

The term cost-sharing may sound like a technicality, but its consequences are human. When a woman receives notice that her mammogram looks abnormal, she is already anxious. Adding a $500 or $1,000 price tag for the next test can turn anxiety into paralysis.

Eliminating those costs is not about convenience. It is about enabling women to complete the diagnostic process, catch cancers earlier, and avoid more invasive treatment later.

The Bottom Line

The United States has made enormous strides in breast cancer awareness, imaging technology, and early detection. Yet the system still leaves too many women behind because of cost.

Missouri’s experience shows that when out-of-pocket expenses are removed, more women follow through with needed imaging, and cancers are caught earlier. True early detection is not only about better machines or new medical guidelines; it is about ensuring that every woman can afford to take the next step in her care.

Insurance reform is not just a financial issue. It is the missing piece of a truly equitable breast cancer strategy.