What breast cancer screenings are covered by insurance?

NORTHAMPTON, Mass. (WWLP) – In light of breast cancer awareness month, we are examining issues that people who have the disease are facing. 22News takes a look at the importance of a screening and how much of it is covered by insurance.

Breast cancer is the most common cancer for women, so getting screened is recommended but medical imaging comes with costs. 22News spoke with Dr. Dan Sieddiqui, the medical director of the Mass General Cooley Dickinson Hospital Cancer Center, about what insurance typically covers when it comes to cancer management.

For an average risk woman, mammograms should start at age 40 and you should have them annually until the age of 74. If you are 75 or older, talk to your physician about scheduling a mammogram.

These regular mammograms are covered by insurance. However, screenings are different if you are considered at high risk for breast cancer. A person is considered at high risk if they have a personal history of breast cancer, family history of breast cancer or history of radiation therapy to the chest. Sharing your family history is important.

“Significant family history means there’s any issue of breast cancer. Ovarian cancer, prostate cancer, it should be brought to the attention of the primary care doctor and sometimes some these patients are actually candidates to undergo the gene testing,” said Dr. Sieddiqui.

If you are higher risk, you could need additional screening and treatment options, including MRIs and ultrasounds. Doctors have to demonstrate that a patient meets these high risk guidelines for tests to be covered by insurance.

“When we calculate the risk of certain women to have lifetime risk of breast cancer, and if that is calculated to be more than 20 percent or more then yes, then the insurance company approves because that’s the national guidelines,” said Dr. Sieddiqui.

He added the grey area is when a women’s risk is from 10 to 20 percent, the majority of the time at that risk level, additional screenings are typically not covered by insurance.