Pennsylvania Expands Access to Lifesaving Breast Exams

When it comes to breast cancer, timing matters. Early detection can mean the difference between a straightforward course of treatment and a far more difficult fight. Yet for too many women, the moment after an abnormal screening has historically come with a second worry beyond health: cost.

That’s exactly the gap Pennsylvania lawmakers set out to close with Act 52 of 2025 — bipartisan legislation championed by Senator Frank Farry and supported by Rep. Kristin Marcell — which is now law.

By removing cost-sharing for essential diagnostic breast exams, the Commonwealth has taken a meaningful step toward ensuring women can follow through on potentially lifesaving care without financial hesitation.

From Screening to Diagnosis — Where the System Broke Down

For years, many insurance plans covered routine screening mammograms while leaving women exposed to out-of-pocket costs for follow-up testing. If a screening flagged something concerning, patients could face deductibles, copays, or coinsurance for diagnostic exams such as diagnostic mammography, breast MRI, or ultrasound.

That distinction mattered more than many realized. Follow-up exams are not “optional” or precautionary; they are often the next required step to determine whether a suspicious finding is benign or something that needs immediate treatment.

Rep. Marcell noted that these diagnostic tests “play a major role in detecting breast cancer as early as possible, when outcomes are strongest.” Act 52 eliminates the financial roadblock that kept too many women from moving forward quickly.

What Act 52 of 2025 Actually Changes

Act 52 updates Pennsylvania’s long-standing Insurance Company Law of 1921 and replaces outdated provisions with a clear modern standard for breast cancer testing coverage.

Under the new law, health insurance policies offered, issued, or renewed in Pennsylvania must provide coverage without cost sharing for three key services:

• Routine mammographic examinations for women age 40 and older, and for women under 40 when recommended by a physician
• Supplemental breast screenings for women assessed to be at least at average risk
• Diagnostic breast examinations when an abnormality is seen or suspected

The phrase “without cost sharing” is crucial. That means no deductible, no copay, and no coinsurance for these exams when they fall within the law’s requirements.

Why Diagnostic Exams Matter So Much

A screening mammogram is only the first look. If something appears unclear or concerning, diagnostic tests provide higher-resolution imaging and targeted evaluation. These are the exams that help physicians determine whether further action is necessary — or whether a patient can breathe a sigh of relief.

By ensuring diagnostic exams are covered the same way screenings are, Act 52 aligns insurance policy with medical reality. The law recognizes that early detection doesn’t stop at a screening appointment; it depends on timely follow-through.

A Broader Definition of Risk — and Smarter Coverage

Importantly, Act 52 doesn’t limit coverage to only those considered “high risk.” The law defines eligibility for diagnostic and supplemental screenings beginning at “average risk and higher,” a move that reflects evolving medical standards.

The legislation also modernizes what qualifies as acceptable breast imaging, explicitly including advanced technologies such as magnetic resonance imaging (MRI) alongside diagnostic mammography and ultrasound when clinically appropriate.

This approach gives physicians flexibility to recommend the most appropriate test based on each patient’s situation, rather than forcing care decisions based on what an insurance plan happens to favor.

Safeguards Without New Barriers

While expanding access, the law preserves existing safeguards. Insurers may still utilize standard utilization review procedures, and the requirements do not mandate coverage for surgical procedures such as mastectomies. Facilities providing mammograms must also meet federal certification standards.

In short, Act 52 focuses narrowly on removing financial friction from early detection — without opening the door to unrelated insurance mandates.

Bipartisan Leadership With Real-World Impact

Rep. Marcell credited Senator Farry’s leadership in shepherding the bill through the legislative process and emphasized its practical impact rather than its politics.

By targeting cost sharing — one of the most common reasons patients delay or avoid follow-up care — the law addresses a real problem with a direct solution. It is a reminder that legislative changes don’t need to be sweeping to be significant; sometimes the most meaningful reforms are the ones that make critical care easier to access at the moment it’s needed most.

A Step Forward for Women’s Health in Pennsylvania

Act 52 of 2025 takes effect within months of its approval and applies to health insurance policies as they are issued or renewed. For women across the Commonwealth, the result is simple but powerful: when a doctor says further testing is needed, cost should no longer be the deciding factor.

As Rep. Marcell emphasized, expanding access to timely diagnostic care strengthens early detection efforts statewide. It also underscores a broader truth — that healthcare policy works best when it removes obstacles instead of creating them.

For Pennsylvania women facing the uncertainty of an abnormal screening, this law brings clarity, confidence, and peace of mind at a moment when all three are needed most.