Highmark Health Plan Members to Receive 100% Coverage for Diagnostic Breast Studies and MRIs

PITTSBURGH - Highmark Inc. today announced a significant enhancement to its health plans, effective Jan. 1, 2026, ensuring all diagnostic breast studies and breast MRIs will be covered at 100%, without any copay or deductible. This new policy applies to all Highmark health plans across Pennsylvania, New York, West Virginia, and Delaware, removing financial barriers for essential breast cancer diagnostics.

This proactive step underscores Highmark's commitment to early detection of cancer, a critical factor in improving patient outcomes and survival rates. By eliminating out-of-pocket costs, Highmark aims to encourage more members to undergo necessary follow-up imaging when recommended by their physicians. The coverage change applies to all Highmark policies - commercial and group policies, Medicare members, Medicaid members, and those with 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."

For many individuals, this new coverage offers profound peace of mind. Rachel Machen, a 45-year-old Highmark member and Allegheny Health Network (AHN) patient from Oakmont, Pa., understands this impact personally. Her first mammogram at age 40 led to a breast cancer diagnosis, highlighting the critical role of timely detection.

"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, such as diagnostic mammograms, breast ultrasounds, and breast MRIs, are used to investigate suspicious findings from a screening mammogram, a physical exam, or other symptoms. These studies are distinct from routine screening mammograms, which are already covered at 100% under preventive care guidelines.

AHN offers extensive access to breast imaging services, including weekly walk-in mammograms available year-round, Monday through Friday at eight convenient locations throughout Western Pennsylvania. This accessibility, combined with Highmark's enhanced coverage, creates a powerful safety net for early detection.

"We know that convenient access to imaging, combined with the removal of financial burdens, dramatically increases the likelihood of early diagnosis," said Matthew Miller, MD, Director of Breast Imaging at AHN. "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 encourages all patients to speak with their physician about appropriate breast cancer screening and diagnostic protocols.