Dec. 23, 2025
Effective Jan. 1, 2026, we’re updating our coverage of breast cancer for some members with group or individual benefit plans.
What’s changing: The following breast cancer screenings will be covered as preventive at no cost to our members if the member does not have a current diagnosis of breast cancer:
- Mammograms
- MRIs,
- CT scans
- Contrast
- Ultrasounds
- Biopsies
- Pathology evaluations
If the member does have a breast cancer diagnosis, the services will be covered with cost sharing, with the following mandated exceptions in Illinois:
- Imaging will be covered without cost sharing regardless of diagnosis.
- Molecular breast imaging will be covered at no cost sharing for members without a cancer diagnosis.
Why the change: This coverage aligns with the Health Resources and Services Administration-supported Women’s Preventive Services Guidelines, the IRS expansion of preventive services and state mandates.
Check eligibility and benefits first through Availity® Essentials or your preferred vendor prior to rendering services. This step will help you know if the changes apply to your patient.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to Blue Cross and Blue Shield of Illinois. BCBSIL makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.