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NYS Mammography Law

effective January 1, 2017

“Get Screened – No Excuses”  legislation in New York State (NYS) was introduced by Governor Andrew Cuomo in 2017 allowing women better access to breast health care and services they need. Please note: Law  does not apply to self funded plans.

The new legislation has three key components:

  • The law eliminates annual deductibles, co pays and co insurances for women with NYS insurance. NYS insurance companies will be responsible for full payment of some breast imaging services such as screening and diagnostic mammograms (including 3D mammography), ultrasound, and MRI. This means patients having these medically necessary services should not have to share in the cost of the procedure. The law was created to encourage women to seek medical services when needed rather than postponing due to a financial burden. Please note that this does not mean women will never have a payment as not all services are covered in full under the law. Insurance companies based outside NYS are not required to follow the NYS law.
  • The law requires all public employers to provide their public employees with four hours of leave each year for breast cancer screening.
  • Extended hours of screening for at least four hours per week will be required of NYS hospitals and hospital extension clinics to help women who have difficulty scheduling mammograms during the typical 9 a.m. to 5 p.m. workday (Elizabeth Wende Breast Care has offered extended hours and select Saturdays since 1995).

Cancer Services Program of New York State  Eligible clients are able to receive clinical breast exams and mammograms. Clients receiving positive screening tests also receive diagnostic testing and are referred to treatment if needed. Eligible clients are also enrolled in the Medicaid Cancer Treatment Program for Medicaid coverage for the duration of their breast cancer treatment.