Confused about insurance? Don’t let it block your mammogram 

October is Breast Cancer Awareness Month, and by now most of us have heard the message: Early detection saves lives.

But knowing you should get a mammogram and actually booking the appointment are two different things. For many people, the barrier isn’t awareness. It’s uncertainty. Will my insurance cover it? What happens if they find something? What if the nearest screening center is miles away? What if the follow-up tests cost more than I can afford?

Those worries are more common than many people realize. A January 2025 report from the American Cancer Society Cancer Action Network (ACS CAN) estimated that more than 1 million women delay recommended follow-up testing after a mammogram because of cost concerns and that about 378,000 may skip future mammograms altogether for fear of what additional testing would cost. The report also found that more than 70% of commercially insured patients faced out-of-pocket costs for follow-up diagnostic tests such as diagnostic mammograms, ultrasounds, MRIs and biopsies.

No one should put off a potentially lifesaving screening because they’re worried about their wallet. Understanding how your coverage works can take some of that uncertainty off the table.

Start with the good news: For many people, a routine mammogram costs nothing. Under the Affordable Care Act, most health plans must cover recommended preventive breast cancer screenings without cost-sharing. In many cases, that means a screening mammogram from an in-network provider comes with no copay, coinsurance or deductible.

Many people know the guideline to begin screening at age 40, but when you should start can depend on your personal risk factors and the recommendations you and your health care provider choose to follow.

Coverage makes a real difference in who gets screened. According to Susan G. Komen, among women ages 50 to 74, only 50% of those without insurance reported having a mammogram in the previous two years, compared with 83% of women with private insurance.

Still, the rules vary depending on your plan, your age, your risk factors and whether a service is considered preventive or diagnostic. Before you schedule, call your health plan or log into your member portal and ask:

• Is the screening provider in-network?
• Is the mammogram considered preventive care under my plan?
• Do I need a referral?
• Are 3D mammograms covered?
• What will I owe if additional testing is needed?

For some people, the challenge isn’t coverage. It’s access. Research continues to show that women in rural communities are less likely than women in urban areas to be up to date on breast cancer screenings, with transportation, distance and a shortage of nearby providers all playing a role.

That’s where mobile mammography comes in. These units bring screening directly into communities, and a recent study found that the women who use them are more likely to come from rural and lower-income areas where traditional imaging centers are hard to reach. For some women, the nearest mammogram may not be at a hospital at all. It may be a mobile unit parked at a community center, a church lot, a workplace or a neighborhood health fair.

Don’t assume your insurance won’t cover a mobile mammogram. Coverage is usually tied to the service and the provider, not the building where the screening happens. Check with both the provider and your health plan ahead of time to confirm.

Men shouldn’t tune this out either. Breast cancer is much less common in men, but it does happen, and the possibility is often overlooked because so many people think of it as a women’s disease. Men who notice a lump, swelling, skin changes or nipple discharge should talk with their health care provider. Routine screening coverage is different for men, but diagnostic testing ordered to evaluate symptoms may be covered. Medicare, for example, covers diagnostic mammograms for men when they are medically necessary.

Then there is the question many people fear most: What happens if something is found?

Being called back for more imaging does not mean you have cancer. Follow-up testing after a screening mammogram is relatively common, and it often turns up findings that are not cancerous.

If you do need more testing or treatment, your insurance plays a role at every stage. Depending on your diagnosis and treatment plan, coverage may include diagnostic imaging, biopsies, specialist visits, surgery, radiation, chemotherapy, prescription drugs and follow-up care. Most plans cover medically necessary cancer treatment, though deductibles, copays, coinsurance and out-of-pocket maximums differ from plan to plan. Ask questions about your benefits early and often.

It also helps to plan for the costs that never show up on a medical bill. A diagnosis can mean paying for transportation, gas and parking, lodging if treatment is far from home, child care, meals and help around the house during recovery, along with time away from work. Depending on your circumstances, help may be available through your health plan, your employer, your health care provider, nonprofit organizations or community programs. Asking about those resources matters just as much as understanding your medical coverage.

Breast cancer screening saves lives, but confusion about coverage, cost and access still keeps too many people from getting screened. The reality is more encouraging than many expect. Many mammograms are covered as preventive care. Mobile options may be closer than you think. And health plans often offer support people don’t know exists.

This month, take a few minutes to learn what your plan covers and what screening options are near you. Knowing what to expect can remove one more barrier between you and a screening that could save your life.

Dr. Angela Porter is senior medical director at Medica. Andrew Marshall is a market president at Medica.