Screening

Mammography

Post-Mastectomy

Services

Inpatient

Care

0

5

10

15

20

25

30

35

40

45

50

55 Screening Mammography

Post-Mastectomy Services

Reconstructive Surgery

Prosthetic Devices

Lymphedema Therapy

Mastectomy

Lymph Node Dissection

Lumpectomy

Inpatient Care

50

36

29

20 21

12

3

Source:  National Cancer Institute: State Cancer Legislative Database Program,Bethesda,MD,2006

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

The SCLD contains information synthesized from state-level laws. The SCLD does not contain state-level regulations; executive orders; measures implemented 

by counties, cities, or other localities; case law; Attorneys General opinions; or data addressing the implementation of state laws—all of which vary significantly 

from the laws reported herein.

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 19 states must provide coverage for lymphedema therapy. Insurers in Kentucky must offer such 

coverage.

• Nineteen 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.

National Cancer Institute

U.S. DEPARTMENT 

OF HEALTH AND 

HUMAN SERVICES

National Institutes 

of Health

Breast Cancer

State Cancer Legislative Database Program Fact Sheet April 2006

Office of Policy Analysis and Response

Coverage By Private Health Insurers

Number of States with Enacted Laws by Type of Service (through December 31, 2005) Number of States with Enacted Laws (Does not include resolutions or regulations)
s = requires insurers to provide coverage

l = requires insurers to offer coverage

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

Source: National Cancer Institute: State Cancer Legislative Database Program, Bethesda, MD, 2006.

Breast Cancer Coverage by Private Health Insurers

Enacted Laws by Type of Service (as of December 31 , 2005)

State

Screening Post-Mastectomy Services Inpatient Care

Mammography

Reconstructive

Surgery Prosthetic Devices Lymphedema Mastectomy

Lymph Node

Dissection Lumpectomy

Alabama s

Alaska s

Arizona s s s s

Arkansas l s s s s

California s s s s s s

Colorado s

Connecticut s s s s

Delaware s s s s

District of Columbia s s s s

Florida s s s s

Georgia s s s

Hawaii s

Idaho s

Illinois s s s s s

Indiana s s s

Iowa s

Kansas s s s s

Kentucky s l l l s

Louisiana s s s s

Maine s s s s s

Maryland s s s

Massachusetts s

Michigan l l l

Minnesota s s s s

Mississippi l

Missouri s s s

Montana s s s s s s

Nebraska s s s s

Nevada s s s

New Hampshire s s

New Jersey s s s s

New Mexico s s s s s

New York s s s

North Carolina s s s s s

North Dakota s s s s

Ohio n

Oklahoma s s s s

Oregon s s s s s

Pennsylvania s s s s s

Rhode Island s s s s s s

South Carolina s s s s

South Dakota s

Tennessee s s

Texas s s s s s s

Utah s s s

Vermont s

Virginia s s s s s s

Washington s s

West Virginia s s s s s s

Wisconsin s

Wyoming s

Totals 50 36 29 20 21 12 3