Yes. A screening mammogram is considered preventive care under federal law, and most health insurance plans must cover it with no copay, no coinsurance, and no deductible. The protection comes from the Affordable Care Act and applies to routine screenings for women within the recommended age range. It does not automatically apply to diagnostic mammograms ordered because of symptoms, and a few categories of health plans are exempt from the rule entirely. What you actually pay often comes down to how the procedure is coded on the bill.
The Federal Rule That Makes Screening Mammograms Free
The Affordable Care Act added a preventive care mandate to the Public Health Service Act, codified at 42 U.S.C. ยง 300gg-13. It requires most group and individual health plans to cover certain preventive services without any cost-sharing.1Office of the Law Revision Counsel. 42 USC 300gg-13 – Coverage of Preventive Health Services Two sets of recommendations trigger the requirement for breast cancer screening: services rated “A” or “B” by the U.S. Preventive Services Task Force, and services recommended in guidelines supported by the Health Resources and Services Administration.
Breast cancer screening carries a “B” rating from the USPSTF for women aged 40 to 74, and HRSA’s Women’s Preventive Services Initiative separately recommends mammography starting no earlier than age 40 and no later than age 50.2United States Preventive Services Taskforce. A and B Recommendations3Federal Register. Update to the HRSA-Supported Women’s Preventive Services Guidelines Because both federal bodies back mammogram coverage, insurers have overlapping legal obligations to pay for it.
How Often You Can Get a Free Mammogram
Under HRSA guidelines, screening mammography should occur at least every two years and as frequently as every year for women at average risk. The USPSTF separately recommends biennial screening for women aged 40 to 74.2United States Preventive Services Taskforce. A and B Recommendations Your insurer must cover screenings that fall within either set of guidelines at no cost.
Ask for a screening more often than the guidelines support without a medical reason, and the extra one can be treated as a standard medical service with normal cost-sharing. Annual or biennial screening keeps you within the preventive benefit.
Many facilities now use digital breast tomosynthesis, often called a 3D mammogram, as part of their standard screening. Because tomosynthesis is classified as a screening mammography service, ACA-compliant plans generally cover it as preventive care. If you are scheduling a mammogram, confirm with the facility that it will be billed under a screening code.
Screening vs. Diagnostic: Why the Billing Code Matters
The single biggest reason people get an unexpected bill for a mammogram is coding. A screening mammogram is a routine check for someone with no current breast symptoms, billed under CPT code 77067. That is the version federal law requires plans to cover at no cost.4Department of Labor. FAQ About Affordable Care Act and Women’s Health and Cancer Rights Act Implementation Part 68
A diagnostic mammogram is a different service. Providers order one when you have specific symptoms, such as a lump, pain, or unusual discharge, or when a prior screening found something that needs a closer look. Diagnostic mammograms are billed under CPT code 77066, and the federal no-cost preventive mandate does not apply.4Department of Labor. FAQ About Affordable Care Act and Women’s Health and Cancer Rights Act Implementation Part 68 That means your plan can apply a copay, deductible, or coinsurance. Out-of-pocket costs for a diagnostic mammogram without coverage typically run from roughly $200 to over $1,000 depending on the facility.
Some states have passed laws requiring insurers to cover diagnostic mammograms and other supplemental breast imaging without cost-sharing, going beyond the federal floor. These laws vary, so check your state insurance department or your plan’s summary of benefits.
Follow-Up Imaging After an Unclear Screening
Historically, a free screening mammogram that turned up something inconclusive could trigger hundreds of dollars in bills for the follow-up ultrasound, MRI, or biopsy. HRSA updated its guidelines in December 2024 to recommend that additional imaging and pathology evaluation needed to complete the screening process also be treated as preventive care.3Federal Register. Update to the HRSA-Supported Women’s Preventive Services Guidelines
Non-grandfathered plans must begin covering those follow-up services without cost-sharing for plan years starting one year after the guideline was published. For most calendar-year plans, that means coverage kicks in starting in 2026. Covered follow-up services include additional mammography views, breast ultrasound, MRI, and biopsy with pathology, as long as they were triggered by the initial preventive screening rather than ordered for a separate medical reason.
What “No Cost-Sharing” Actually Means in Practice
When federal law says a screening mammogram must be covered without cost-sharing, your insurer pays the full amount. You owe no copay, no coinsurance, and the cost cannot be applied to your deductible. Two practical details affect whether you actually pay nothing.
The protection applies when you use an in-network provider. If your plan has a network and you go out of network, the insurer can charge cost-sharing. The exception is when your plan has no in-network provider who can perform the screening, in which case it must cover an out-of-network screening at no cost.5Department of Labor. FAQs About Affordable Care Act and Women’s Health and Cancer Rights Act Implementation Part 68
If the main purpose of your appointment is the screening mammogram, the associated office visit should also be covered without cost-sharing, since plans must cover services integral to delivering a recommended preventive service.4Department of Labor. FAQ About Affordable Care Act and Women’s Health and Cancer Rights Act Implementation Part 68 If your doctor addresses unrelated health concerns at the same visit, those additional services can be billed separately with normal cost-sharing.
Plans That Don’t Have to Follow the Rule
Not every plan is subject to the ACA’s preventive care mandate.
Grandfathered Plans
Plans that existed on or before March 23, 2010, and have not made significant changes since can keep “grandfathered” status, which exempts them from the no-cost preventive requirement. Significant changes that cost a plan this status include eliminating benefits for a condition, raising coinsurance percentages above March 2010 levels, or increasing deductibles or copays beyond specified thresholds.6eCFR. 45 CFR 147.140 – Preservation of Right to Maintain Existing Coverage Because plans tend to change year to year, most grandfathered plans have already lost the status. If your plan materials do not say the plan is grandfathered, it almost certainly is not.
Short-Term Health Plans
Short-term, limited-duration insurance is not minimum essential coverage under the ACA and is not subject to the preventive care mandates. These policies frequently do not cover preventive screenings at all, or cover them only with significant cost-sharing. On a short-term plan, assume your mammogram will not be free unless your policy documents say otherwise.
Medicare Rules Are Separate
Medicare follows its own framework rather than the ACA preventive rules. Under Medicare Part B, screening mammograms are covered once every 12 months for women aged 40 and older at no cost to you, provided your provider accepts Medicare assignment.7Medicare.gov. Mammograms Women aged 35 to 39 are covered for one baseline screening.
Diagnostic mammograms under Medicare work differently. After you meet the Part B deductible, you pay 20 percent of the Medicare-approved amount.7Medicare.gov. Mammograms The screening-versus-diagnostic distinction matters for Medicare beneficiaries just as much as for anyone with private insurance.
If You Get Billed Anyway
Billing errors happen. A screening mammogram can be miscoded as diagnostic, or an insurer’s automated system can apply cost-sharing to a service that should have been free. You have the right to challenge the charge.
The quickest fix is often a phone call to your provider’s billing department. If the facility used a diagnostic CPT code instead of a screening code, ask them to correct and resubmit the claim before you start a formal appeal.
Internal Appeal
You have 180 days from the date of a denial notice to file an internal appeal with your insurer.8HealthCare.gov. Internal Appeals Submit a written request with your name, claim number, and insurance ID, and attach supporting documentation, such as a letter from your provider confirming the mammogram was a routine screening. The insurer must decide within 60 days for a service you already received, or 30 days for one you have not yet received.
External Review
If the internal appeal is denied, you can request an independent external review. You have four months from the date of the final internal denial to file.9HealthCare.gov. Appealing a Health Plan Decision – External Review A reviewer not employed by your insurer evaluates the claim, and the insurer is legally required to accept the decision. The external review is either free or capped at $25 depending on your state’s process.