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Breast Cancer Screening Changes for 2026: HRSA, IRS and State Updates

Dec. 17, 2025

(Applies to Non-Grandfathered Group plans; Individual & Family Markets*)

We are updating our coverage of breast cancer screenings in alignment with the Health Resources and Services Administration (HRSA)-supported Women’s Preventive Services Guidelines, the IRS expansion of preventive services and state mandates.

What you need to know: There are changes to the coverage of breast cancer screenings beginning with the 2026 plan year. These changes are the result of updated federal preventive recommendations and state mandates.

What’s changing on a federal level for Individual & Family Markets, Fully Insured and ASO non-grandfathered groups?

Breast cancer screenings, including mammograms, MRIs, CT scans, contrast, ultrasounds, biopsies and pathology evaluations will be covered as preventive without cost sharing. Preventive service coverage means the member does not have a current diagnosis of breast cancer.

If the member has a cancer diagnosis, the services will be covered with cost sharing (see state exceptions below). This is true for members of non-high deductible health plans and members of high deductible health plans.

Reminder: As with any preventive service, services are covered without cost sharing only when obtained from in-network providers.

What’s changing on a state level for plans subject to state mandates (including Blue Balance Funded℠)?

  • MBI will also be covered without cost sharing.

Reminder: For members subject to the federal coverage, state mandated coverage will be in addition to the ACA preventive coverage. For state mandated coverage not covered as an ACA preventive service, HDHP members must meet their deductible first for those services to be covered without cost sharing.

When are these changes going into effect?

  • Federal changes go into effect Jan 1. 2026, regardless of renewal.
  • State-mandated changes: The state-mandated changes went into effect upon renewal on or after Nov. 1, 2025.

What guidance/state mandates relate to this change?

HRSA-supported Women’s Preventive Services Guidelines

HRSA updated its guidelines related to recommendations for breast cancer screening, screening and counseling for intimate partner violence, and patient navigation services for breast and cervical cancer. The breast cancer screening changes are outlined above.

  • The recommendation for screening and counseling for intimate partner and domestic violence is already covered in alignment with the updated HRSA guidance.
  • We currently cover patient navigation services for breast and cervical cancer but are updating our policy to align with the recommendations.

IRS Guidance

IRS notice 2024-75 updates the list of services that an HDHP can cover as preventive care without cost sharing. These services include all breast cancer screenings for members who have not been diagnosed with breast cancer.

State Mandates

The following state mandates expanded or updated breast cancer coverage:

  • Oklahoma House Bill 1389 updated previous requirements to include supplemental breast cancer screening coverage without cost sharing.

*This article, or a similar version, is being shared with employer groups in our employer newsletter or news alert.