Millions of people across the country now have access to mammograms with no out-of-pocket costs, thanks to its inclusion as a required essential benefit under the provision of the federal Affordable Care Act (ACA). However, if the results of that mammogram suggest the need for a follow-up exam to determine if the patient has breast cancer, they may be faced with hundreds to thousands of dollars in out-of-pocket costs — all before potentially starting treatment.
 
WHAT THIS BILL DOES

• SB711 and HB4410: An Act Relative to Breast Cancer Equity and Early Detection, would ensure patients can access a follow-up breast imaging and exams with no out-of-pocket costs.
• Requires Medicaid, the Group Insurance Commission (GIC) and commercial health plans regulated by the Commonwealth to cover diagnostic breast imaging including, diagnostic mammography, breast ultrasound and magnetic resonance imaging (MRI), with no out-of-pocket costs. Diagnostic breast imaging is used as a follow-up exam after an abnormal finding on a mammogram or clinical breast exam.

 
WHY THIS MATTERS 

• From an early detection perspective, a screening mammogram would not be considered successful if the follow-up diagnostic imaging were not performed to either rule out breast cancer or confirm the need for a biopsy.
• There are stark disparities in the outcomes of breast cancer patients. Despite having a lower breast cancer incidence, Black patients have the highest breast cancer mortality rate of any race. Reducing barriers to early breast cancer detection is the key to addressing these disparities.
• COVID-19 has caused significant delays in screening mammograms and created economic hardship for people across the Commonwealth. If a patient is unable to afford the out-of-pocket costs for diagnostic imaging, many might delay or forego additional tests to rule out or confirm a breast cancer diagnosis. This delay can mean a patient won’t seek care until cancer has spread beyond the breast, making it much deadlier and much more costly to treat.
• Massachusetts is lagging behind other states that have passed similar legislation, including Maine, Vermont, New York, Colorado, Illinois, Louisiana, and Texas.