Insurance Mammograms Coverage - Unchanged In NY State

Woman undergoing a mammogram of the right breast.

Governor David A. Paterson announced last week that insurance companies in New York are still required to pay for mammograms with the same frequency as before the recent federal advisory that suggested fewer mammograms. The consumer protections that were previously established for insurance coverage of women’s mammograms remain in effect and are unchanged by the recent screening guideline revisions announced by the U.S. Preventive Services Task Force.

“Women in New York should know that health insurance companies in the State are still required to cover mammograms starting at age 35 or whenever a doctor believes they are medically necessary. That law has not changed,” Governor Paterson said. “The revised screening guidelines have not reduced the State mandated insurance coverage of mammograms.”

The U.S. Preventive Services Task Force recently changed its recommendations regarding the age at which women should begin having mammograms and the frequency of mammograms. The Task Force’s new recommendations suggest mammograms should begin at age 50 for most women, rather than the previous recommendation of age 40. Other medical organizations believe the age 40 recommendation should remain unchanged.

New York law requires that health insurance cover:

• Mammograms at any age when recommended by a doctor for women who have a prior history of breast cancer or whose mother or sister has a prior history of breast cancer;
• A mammogram every two years, or more frequently if a doctor recommends, for women aged forty to forty-nine; and
• An annual mammogram for women aged fifty and older.

“Women of all ages should discuss this and other health screenings with their physician,” the Governor added.

Insurance Superintendent James J. Wrynn said: “The Insurance Department will ensure that insurers continue to cover mammograms. Any woman having problems with her health insurer should call our consumer help line at 800-342-3736.”

State Health Commissioner Richard F. Daines, M.D., said: “Women should continue to consult with their physicians about their personal need for mammograms and other medical tests. The doctor-patient relationship remains the standard in New York.”