Fact Sheet: Breast Cancer

All 50 states and the District of Columbia (collectively, states)

have enacted laws addressing private health insurance coverage

for breast cancer screening and/or breast cancer-related services. The bar chart above illustrates the number of states with

laws addressing private health insurance coverage for:

(1) screening mammography; (2) post-mastectomy services (i.e.,

reconstructive surgery, prosthetic devices, and therapy for lymphedema); and (3) inpatient care following a mastectomy,lymph

node dissection, or lumpectomy.

Screening Mammography

• All states except Utah have enacted legislation addressing

mammography coverage.

• Forty-six states require insurers to provide coverage for screening mammography; Arkansas, Michigan, and Mississippi

require insurers to offer such coverage.

• Ohio’s law is unique: it requires certain insurers to provide coverage and others to offer coverage.

Post-Mastectomy Services

• Thirty-six states have enacted legislation addressing coverage

for post-mastectomy services.

• Thirty-four states require insurers to provide coverage for

reconstructive surgery after mastectomy, including surgery to

establish breast symmetry. Kentucky law mandates that insurers offer such coverage and Michigan law mandates that insurers offer or include such coverage.

• Twenty-seven states require insurers to provide coverage for

prosthetic devices after surgery; in Kentucky, insurers must

offer such coverage and in Michigan, insurers must offer or

include such coverage.

• Twenty-seven states require insurers to provide coverage for

both reconstruction and prostheses; Kentucky requires insurers to offer coverage for both reconstruction and prostheses;

Michigan requires insurers to offer or include such coverage.

• Insurers in 18 states must provide coverage for lymphedema

therapy. Insurers in Kentucky must offer such coverage.

• Eighteen states require insurers to provide coverage for reconstructive surgery, prostheses, and lymphedema therapy.

Kentucky requires insurers to offer such coverage.

Inpatient Care

• Twenty-one states have enacted legislation requiring insurers

to provide inpatient care following a mastectomy.

• Twelve states require insurers to provide coverage for inpatient

care following lymph node dissection.

• Twelve states require insurers to provide coverage for inpatient

care following both mastectomy and lymph node dissection.

• Three states—Maine,Montana, and New York—require insurers to provide coverage for inpatient care following mastectomy, lymph node dissection, and lumpectomy.

Source: National Cancer Institute: State Cancer Legislative Database Program, Bethesda, MD, 2004.

Building 31, Room 10A48 • 31 Center Drive, MSC 2580 • Bethesda, Maryland 20892-2580 • 301 496 5217 • 301 402 1225 fax • http://www.scld-nci.net

NATIONAL CANCER INSTITUTE · STATE CANCER LEGISLATIVE DATABASE PROGRAM APRIL 2004

Coverage By Private Health Insurers

Number of States with Enacted Laws by Type of Service (through December 31, 2003)

Screening

Mammography

Post-Mastectomy

Services

Inpatient

Car

10

15

20

25

30

35

40

45

50

55 Screening Mammography

Post-Mastectomy Services

Reconstructive Surgery

Prosthetic Devices

Lymphedema Therapy

Mastectom

Lymph Node Dissection

Lumpectom

Inpatient Car

50

36

29

19 21

12

State Cancer 

Legislative Database

Program, NCI

Number of States with Enacted L

a

ws

(Does not include resolutions or regulations)

The SCLD contains information synthesized from state-level laws. The SCLD does not contain state-level regulations; measures implemented by counties,cities,or other localities; case law; opinions of the Attorneys General; or data addressing the implementation of state laws—all of which may vary significantly from the laws reported herein.
▲ = requires insurers to provide coverage

● = requires insurers to offer coverage

Breast Cancer Coverage by Private Health Insurers

Enacted Laws by Type of Service (through December 31, 2003)

Source: National Cancer Institute: State Cancer Legislative Database Program, Bethesda, MD, 2004.

State

Screening Post-Mastectomy Services Inpatient Care

Mammography

ReconstructiveSurgery

ProstheticDevices

Lymphedema

Mastectomy

Lymph NodeDissectionLumpectomy

Alabama ▲

Alaska ▲

Arizona ▲ ▲ ▲ ▲

Arkansas ● ▲ ▲ ▲ ▲

California ▲ ▲ ▲ ▲ ▲ ▲

Colorado ▲

Connecticut ▲ ▲ ▲ ▲

Delaware ▲ ▲ ▲ ▲

District of Columbia ▲ ▲ ▲ ▲

Florida ▲ ▲ ▲ ▲

Georgia ▲ ▲ ▲

Hawaii ▲

Idaho ▲

Illinois ▲ ▲ ▲ ▲ ▲

Indiana ▲ ▲ ▲

Iowa ▲

Kansas ▲ ▲ ▲ ▲

Kentucky ▲ ● ● ● ▲

Louisiana ▲ ▲ ▲ ▲

Maine ▲ ▲ ▲ ▲ ▲

Maryland ▲ ▲ ▲

Massachusetts ▲

Michigan ● ● ●

Minnesota ▲ ▲ ▲ ▲

Mississippi ●

Missouri ▲ ▲ ▲

Montana ▲ ▲ ▲ ▲ ▲ ▲

Nebraska ▲ ▲ ▲ ▲

Nevada ▲ ▲ ▲

New Hampshire ▲ ▲

New Jersey ▲ ▲ ▲ ▲

New Mexico ▲ ▲ ▲

New York ▲ ▲ ▲ ▲ ▲

North Carolina ▲ ▲ ▲ ▲ ▲

North Dakota ▲ ▲ ▲ ▲

Ohio ■

Oklahoma ▲ ▲ ▲ ▲

Oregon ▲ ▲ ▲ ▲ ▲

Pennsylvania ▲ ▲ ▲ ▲ ▲

Rhode Island ▲ ▲ ▲ ▲ ▲

South Carolina ▲ ▲ ▲ ▲

South Dakota ▲

Tennessee ▲ ▲

Texas ▲ ▲ ▲ ▲ ▲ ▲

Utah ▲ ▲ ▲

Vermont ▲

Virginia ▲ ▲ ▲ ▲ ▲ ▲

Washington ▲ ▲

West Virginia ▲ ▲ ▲ ▲ ▲ ▲

Wisconsin ▲

Wyoming ▲

TOTAL 50 36 29 19 21 12 3

■ = specifies that certain private insurers must provide coverage while others must offer coverage