What Wisconsin’s New “Gail’s Law” Means for Breast Screening

Wisconsin’s new Gail’s Law (2025 WI Act 103) is designed to improve access to breast imaging for people who may have a higher risk of breast cancer or who have dense breast tissue.

Starting with applicable plan years beginning January 1, 2027, Wisconsin health insurance plans, including Medicaid, will be required to cover certain medically necessary breast imaging.

What does this mean for you?

• If you have heterogeneously or extremely dense breasts or a strong family history of breast cancer, talk with your healthcare provider about whether supplemental screening, such as a breast MRI or ultrasound, may be appropriate.

• If your mammogram finds an abnormality and you need additional diagnostic imaging, such as a diagnostic mammogram, ultrasound, MRI, or 3D mammogram, the law provides important cost protections.

• The law provides no out-of-pocket cost for diagnostic breast exams and for the first supplemental screening exam each policy year, when the requirements of the law apply.

• Your provider must recommend and refer you for supplemental MRI or ultrasound, you cannot simply schedule these tests on your own.

One important reminder: Insurance coverage and plan-year rules can vary. Before scheduling additional imaging, contact your insurance plan to confirm that the service is covered under Gail’s Law and that you will not have unexpected out-of-pocket costs.

If you’ve received a letter saying you have dense breast tissue, consider talking with your healthcare provider about what your results mean and whether additional screening is right for you.

Information based on the Wisconsin Breast Cancer Coalition’s summary of Gail’s Law. This is educational information, not medical or insurance advice.