insurance; cost sharing; breast exams

Lower breast screening costs, with limits

Starting January 1, 2027, Arizona hospital and medical service corporations, health care services organizations, and disability insurers cannot charge cost sharing for covered breast screening services under qualifying policies issued, amended, delivered, or renewed on or after that date. The rule covers screening mammograms and medically necessary diagnostic or supplemental breast exams under national cancer guidelines, including mammography, MRI, ultrasound, and molecular breast imaging. Diagnostic exams evaluate an abnormality; supplemental exams can screen when no abnormality is seen or when risk factors such as very dense breasts are present. For high-deductible plans, nonpreventive services are covered without cost sharing only after the deductible is met; preventive services under the cited federal rule are exempt from that deductible requirement.