Blue Cross Mammogram Coverage: Preventive Service Details

Standard Coverage

Under the Affordable Care Act (ACA), most Blue Cross Blue Shield (BCBS) plans cover screening mammography as a preventive service with $0 cost-sharing (no deductible, copay, or coinsurance) for women ≥40 (or younger with risk factors).

Variables That Affect Coverage

• Plan type: HMO, PPO, EPO, HDHP—all ACA-compliant plans must cover.
• Age/frequency: Typically annually 40–74; biennial 55+ per USPSTF; some plans follow ACS (annual 45–54).
• Diagnostic vs. screening: Diagnostic mammo (symptom-driven) may incur cost-share.
• Network: In-network facility required for $0; out-of-network may apply deductible/coinsurance.
• Grandfathered plans: Pre-ACA plans exempt from preventive mandate.

Action

Call the member-services number on your ID card; ask: "Is screening mammogram covered at 100% in-network for my age/plan?"