While there is much uncertainty these days regarding health care costs, there is some good news for Virginians regarding follow-up and supplemental breast imaging that is needed to diagnose or rule out breast cancer. VBCF’s advocates helped us pass legislation in 2025 that prohibits state-regulated health insurance plans from charging out-of-pocket costs (co-pays, coinsurance or deductibles) for diagnostic and supplemental breast imaging – including diagnostic mammograms, ultrasounds, and MRIs. The law went into effect on January 1, 2026 and will help remove cost as a barrier to early detection.
Have questions? VBCF’s Fact Sheet and FAQs explain the new law in more detail.
Will this law help you?
First things first, do you have a health insurance plan that is regulated by the Commonwealth of Virginia? Most commonly, this means you get your health insurance through the Virginia Marketplace. If that’s the case, then you are covered by this law. But, if you get your health insurance through your employer, chances are your plan is not impacted by this new state law. Please read our Fact Sheet and FAQs to learn more about different types of health insurance.
Here are a few examples of how the new state law will work:
Scenario #1:
Jane had her annual screening mammogram (make your appointment for the new year!). Afterwards, her doctor’s office called to let her know that something unusual came up on the mammogram and that her doctor would like her to come back in for a diagnostic mammogram to take a closer look. In the past, when Jane had to return for more imaging, she had to pay a large co-pay, so she is worried about the cost this time around. Good news! Because of the new law, she will not have to pay anything for her follow-up imaging.
Scenario #2:
Beth’s mother and aunt both had breast cancer. Due to this family history, Beth is considered at high-risk of breast cancer, and her doctor would like her to get a breast MRI in addition to her screening mammogram. This is regarded as supplemental imaging. With the new law in effect, Beth should not have to pay any out of pocket expenses for the MRI.
Remember, in these scenarios, both Beth and Jane are insured under Virginia law. If you are unsure what type of health insurance you have, it’s a good idea to call your insurer to double-check, BEFORE you schedule follow-up or supplemental breast imaging. See our Fact Sheet and FAQs for more information.
Why Was this Law Neccessary?
Find out why VBCF pushed for this law to make early detection more accessible.
Coverage Check: What You Should Know
In addition to Virginia’s new law, updates to federal guidelines effective 1/1/26 require federally regulated health insurance plans to cover follow-up imaging needed after a screening mammogram at no cost to women at average risk of breast cancer. Coverage can vary, so contact your health insurance provider before scheduling imaging to confirm what your plan covers.
2 Responses
According to the Virginia Department of Human Resource Management, this benefit does not extend to state employees under state health insurance plans. I contacted them after being charged for a follow up exam in March and was caught off guard by the cost. Your website states that state employee plans are included under the law (though there is an exemption for self insured plans) – I’m not sure if this is an error or if some other error has been made from the state side. I find it hard to believe that the General Assembly would require private insurance to cover such exams and not require their own plans to do the same.
Hi Tracey,
Thanks for raising this. The law went into effect on Jan 1, 2026. But, the state employee health care plan renews based on Virginia’s fiscal year: July 1, 2026- June 30, 2027). Therefore, the law will apply to state employee health care insurance plans beginning July 1, 2026. I appreciate you flagging this, and we will make changes to clarify this on our website materials. Please reach out if you have any questions. kirsta@vbcf.org