Act 52 Frequently Asked Questions

Have questions about Act 52 of 2025? Want to know if YOU are covered by the law? Read our FAQs below to learn more.

opens in a new windowAct 52 of 2025 eliminates all costs associated with diagnostic breast imaging, including mammograms, breast MRI, and ultrasounds for individuals insured under Pennsylvania law. Act 52 builds on the comprehensive coverage of opens in a new windowAct 1 of 2023, which applies to supplemental screening and genetic testing for individuals at increased risk for breast cancer.

A screening is your routine breast imaging. Screenings are done when an individual has no symptoms of breast cancer. Diagnostic breast imaging is used when there is a specific concern to investigate.

Act 52 implementation varies by type of insurance plan. Large group plans will begin taking effect as early as July 17, 2026. Individual, such as those purchased through Pennie, and small group plans must have coverage required by Act 52 implemented by January 1, 2028. Act 52 does not apply to Pennsylvanians with self-insured plans or to those covered by Medicare.

If you are insured under Pennsylvania law and have coverage through Highmark, you are already covered.
(Thanks, Highmark!). opens in a new windowClick here to learn more.

Act 52 covers individuals whose insurance is state-regulated. This can include plans purchased through the Pennie marketplace or employer-provided insurance. To find out if your employer-covered plan is insured under Pennsylvania law, contact your human resources or benefits administrator. If you are insured under Pennsylvania law (if your insurance is state-regulated), you are covered under Act 52.

The Pennsylvania Department of Health offers no-cost mammograms and follow-up imaging like MRI and ultrasound through its Breast and Cervical Cancer Early Detection Program (BCCEDP) for women who are uninsured or underinsured. Please contact our Director of Patient Advocacy, Dolores Magro, at 800-377-8828 ext. 3020 or Dolores@PABreastCancer.orgcreate new email to learn more. opens in a new windowClick here to learn more about BCCEDP.

If you have a federally regulated high-deductible plan, you may be considered underinsured. Underinsured means you have health insurance, but it does not pay for all of your breast cancer screening or testing. The PA Department of Health’s Breast and Cervical Cancer Early Detection Program (BCCEDP) may be able to pay the part your insurance doesn’t pay. Please contact the PBCC’s Director of Patient Advocacy, Dolores Magro, at 800-377-8828 ext. 3020 or Dolores@PABreastCancer.orgcreate new email to learn more.

If you are have questions about your insurance coverage, please reach out to your insurer or employer directly. For additional questions about Act 52, contact our office at 800-377-8828, email Info@PABreastCancer.orgcreate new email or call the Pennsylvania Insurance Department at 1-877-881-6388.