Expanding Coverage for Supplemental Breast Cancer Screenings Effective 1/1/26
IMPACTED PLANS: QHP, EP, Gold, Gold Care
Dear MetroPlusHealth Provider,
This notice serves as a reminder to participating providers of New York State requirements for breast cancer screening and related services. Under state law, breast-cancer-related services must be covered at no cost to the member.
Members must not be charged cost-sharing for the services listed below:
- All mammograms (screening and diagnostic), including those performed more frequently than federal guidelines.
- Diagnostic breast imaging, including:
- Diagnostic mammograms
- Breast ultrasounds
- Breast MRIs
Providers must ensure that members are not billed deductibles, copayments or coinsurance for the services listed above. These services must be provided by participating (in-network) providers, unless no appropriate provider is available within the network. Diagnostic services performed beyond routine screening mammograms must not result in any additional out-of-pocket cost to the member.
If you have any questions regarding this memo, please contact MetroPlusHealth at [email protected].