Does Obamacare Cover Mammograms? Costs, Exceptions, and 2026 Changes

Yes. Does Obamacare cover mammograms? Under the Affordable Care Act, almost all health plans must cover a screening mammogram for women aged 40 and older with no copayment, no coinsurance, and no deductible, as long as you use an in-network provider and the visit is billed as preventive screening rather than diagnostic.¹²³

Who Qualifies and How Often

Section 2713 of the Public Health Service Act requires non-grandfathered health plans to cover preventive services that receive an “A” or “B” grade from the U.S. Preventive Services Task Force, as well as services recommended by the Health Resources and Services Administration, with no cost-sharing when you stay in network.¹ That means your plan has to pay even if you haven’t met your annual deductible.

For breast cancer, both the USPSTF and the HRSA-supported Women’s Preventive Services Initiative now recommend that women at average risk begin screening mammography at age 40 and continue at least every two years through age 74.⁴⁵ The USPSTF finalized that updated recommendation on April 30, 2024, assigning it a “B” grade. The earlier 2016 guidance had told women in their 40s to weigh the decision individually with a doctor; the new version simply says start at 40.⁶⁷

ACA coverage goes beyond the mammogram itself. Plans must also cover genetic counseling and BRCA1/BRCA2 testing at no cost for women with a qualifying personal or family history of breast cancer, and preventive medications like tamoxifen or aromatase inhibitors for women aged 35 and older at elevated risk.⁵

When You Might Still Get a Bill

The no-cost guarantee has real limits. Knowing them is the difference between a free visit and an unexpected invoice.

Diagnostic mammograms. If you go in because you felt a lump, have other symptoms, or need a follow-up after a prior abnormal finding, the mammogram is classified as diagnostic rather than preventive. Diagnostic mammograms are subject to your plan’s normal cost-sharing: deductible, copay, and coinsurance all apply.⁸

3D mammograms (tomosynthesis). Federal law does not require plans to cover 3D mammograms as a free preventive service, because the USPSTF has not issued a recommendation on them. Coverage depends on your plan and state. Connecticut, Arkansas, Illinois, Kentucky, Louisiana, Massachusetts, and Washington are among the states that require at least some insurers to cover 3D mammograms without cost-sharing, and Minnesota requires it for high-risk women.⁹¹⁰ State mandates generally do not reach self-funded employer plans.

Follow-up imaging for dense breasts, before 2026. Additional imaging ordered because you have dense breast tissue is not currently required to be covered without cost-sharing under federal law.⁵ In 2025, Arkansas, Colorado, Florida, Oklahoma, and Virginia all passed laws eliminating cost-sharing for diagnostic and supplemental breast imaging, joining other states that acted earlier.¹¹ A federal bill, the Find It Early Act, would require all plans (including Medicare, TRICARE, and VA benefits) to cover supplemental and diagnostic breast imaging at no cost for women with dense breasts or elevated risk; as of mid-2025 it was pending in committee.¹²

Grandfathered and short-term plans. A grandfathered plan, one in effect before March 23, 2010, and not substantially changed since, is not required to cover preventive services at no cost.¹³ Short-term health plans lasting less than four months are also exempt.¹⁴ If you’re unsure which category your plan falls into, your insurer or HR department can tell you.

Out-of-network providers. The no-cost rule applies only when the mammogram is performed in your plan’s network.¹

What’s Changing in 2026

In December 2024, HRSA updated its Women’s Preventive Services Guidelines to broaden what plans must cover for free. For plan years beginning on or after late December 2025 (January 1, 2026, for most calendar-year plans), non-grandfathered group health plans must cover additional services when an initial screening mammogram indicates more evaluation is needed.³

Newly covered at no cost:

Additional mammograms beyond the initial screening when clinically indicated.
Supplemental ultrasounds and MRIs to address findings from the initial mammogram.
Biopsies and pathology evaluations needed to complete the screening process.
Patient navigation services, meaning person-to-person support (in person, virtual, or hybrid) to help patients access and complete screening, including scheduling, referrals for transportation and translation, education, and care coordination.⁴¹⁵

Until your plan year rolls over into the new rule, the pre-2026 limits on follow-up imaging still apply.

How to Keep the Visit Coded as Preventive

The most common reason women get billed for a mammogram they expected to be free is that the visit was coded as diagnostic. This can happen if you mention a symptom at check-in, if a prior abnormal result triggers a follow-up classification, or if the facility uses the wrong billing code.

Ask the scheduling office or your insurer which CPT code will be used. A screening mammogram of both breasts is 77067, with 77063 added for 3D. Diagnostic mammograms use 77065 and 77066 and carry standard cost-sharing.¹⁶
Confirm the provider is in your plan’s network.
If you have no symptoms, say so clearly at check-in so the visit is booked as routine screening.
If the radiologist calls you back for additional views on the same visit, ask whether that will be billed as screening or diagnostic; policies vary.

Medicare and Medicaid

Original Medicare is separate from the ACA’s preventive mandate, but it offers similar coverage. Medicare Part B covers a screening mammogram at no cost once every 12 months for women aged 40 and older, with no referral required, and a one-time baseline mammogram for women aged 35 to 39. Diagnostic mammograms are covered but carry a 20% coinsurance after the Part B deductible, which is $283 in 2026. There is no upper age cutoff.¹⁷¹⁸

Medicaid coverage varies by state. Women enrolled through ACA Medicaid expansion get the same no-cost preventive screening as those with private insurance. For traditional Medicaid, breast cancer screening is optional at the federal level, but most states cover it under both pathways.⁵ Every state also participates in the Breast and Cervical Cancer Treatment Program, which extends Medicaid coverage to uninsured women under 65 who are diagnosed with breast cancer through the CDC’s screening program.¹⁹

If You’re Uninsured

The CDC’s National Breast and Cervical Cancer Early Detection Program provides free or low-cost mammograms to women who lack adequate insurance. To qualify, you generally must be between 40 and 64, uninsured or underinsured, and have household income at or below 250% of the federal poverty level. In 2024, that was roughly $37,650 for a single-person household and about $78,000 for a family of four.¹⁴ Women diagnosed through the program can qualify for Medicaid coverage for treatment.²⁰ Local program contacts are listed by state at cdc.gov, or by phone at 800-232-4636.²¹

Is This Coverage Secure?

For several years, the ACA’s entire no-cost preventive services framework was under legal challenge. On June 27, 2025, the Supreme Court ruled 6-3 in Kennedy v. Braidwood Management, Inc. that the USPSTF’s structure is constitutional, preserving no-cost coverage for over 50 preventive services affecting roughly 100 million privately insured Americans, with breast cancer screening among the most prominent.²²² HRSA’s authority to issue the binding screening guidelines described above is not currently in dispute.²³

1
HealthCare.gov. Preventive Care Benefits for Women
2
Supreme Court of the United States. Kennedy v. Braidwood Management, Inc.
3
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4
HRSA. Womens Preventive Services Guidelines
5
KFF. Coverage of Breast Cancer Screening and Prevention Services
6
USPSTF. Breast Cancer Screening Recommendation
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JAMA Network. US Preventive Services Task Force Recommendation Statement on Breast Cancer Screening
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DenseBreast-info. Does Insurance Cover My Mammogram and Any Additional Tests
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DenseBreast-info. State Law Insurance Map
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Minnesota Department of Commerce. Retrospective Evaluation Report on 3D Mammogram Coverage
11
ACR. Seven States Enact Breast Health Legislation
12
Congress.gov. S.1410, Find It Early Act
13
CMS. Preventive Care Background
14
WebMD. Free Breast Cancer Screening
15
WPSI. Patient Navigation Services for Breast and Cervical Cancer Screening
16
DenseBreast-info. What Are Insurance Billing Codes for Additional Breast Screening Tests
17
Medicare.gov. Mammograms
18
Humana. Does Medicare Cover Mammograms
19
KFF. State Eligibility for Medicaid Breast and Cervical Cancer Treatment Program
20
CDC. Breast and Cervical Cancer Screening
21
CDC. Find a Screening Program Near You
22
GW Publichealth. Kennedy v. Braidwood Management, Inc.
23
Mercer. Looking Ahead to Expanded Breast Cancer Screening Coverage Requirement