Highmark Inc. has announced that, starting January 1, 2026, all of its health plans will cover diagnostic breast studies and breast MRIs at 100%, eliminating copays and deductibles for these services. This policy applies to Highmark members in Pennsylvania, New York, West Virginia, and Delaware.
The company stated that this move is intended to remove financial barriers to important breast cancer diagnostics. The coverage change will affect all Highmark policies, including commercial and group plans as well as Medicare, Medicaid, and individual ACA plans.
“Early detection is paramount in the fight against breast cancer. When breast cancer is found early, before it has spread, the five-year survival rate is significantly higher,” said Timothy Law, DO, MBA, Chief Medical Officer at Highmark Inc. “By completely covering diagnostic breast studies and MRIs, we are removing a major financial hurdle that can often delay or prevent individuals from getting the crucial imaging they need. This initiative is about empowering our members to prioritize their health and access timely, life-saving care without financial worry.”
Rachel Machen of Oakmont, Pennsylvania—a Highmark member and Allegheny Health Network (AHN) patient—shared her perspective on the impact of such coverage after her own experience with a mammogram at age 40 led to a diagnosis of breast cancer. “So often, women hear ‘suspicious finding’ and immediately think about the financial stress of follow-up tests on top of the emotional stress,” said Machen. “This new coverage will absolutely encourage more patients to get their mammograms and not hesitate to get those crucial diagnostic studies if needed. It can make all the difference.”
Diagnostic breast studies include procedures such as diagnostic mammograms, ultrasounds, and MRIs used when there are suspicious findings from screenings or physical exams. These differ from routine screening mammograms—which are already fully covered under preventive care guidelines.
AHN provides broad access to breast imaging services in Western Pennsylvania through weekly walk-in mammograms available year-round at eight locations during weekdays. Matthew Miller, MD, Director of Breast Imaging at AHN commented on the significance of removing cost concerns: “We know that convenient access to imaging, combined with the removal of financial burdens, dramatically increases the likelihood of early diagnosis,” he said. “Highmark’s decision to cover these critical diagnostic tests at 100% is a game-changer for our patients. It ensures that when a finding needs further investigation, there’s no hesitation due to cost, allowing us to identify and address potential cancers sooner, when treatment is most effective.”
AHN recommends patients consult their physicians regarding appropriate screening protocols for breast cancer.
