IllinoisIllinois law sets insurance coverage rules for breast screenings
Beginning January 1, 2028, Illinois law provides insurance coverage rules for breast screenings and reconstruction after medically necessary mastectomies.
What it does
Insurers cover screening mammograms based on age and medical need, plus certain ultrasound, MRI, and other breast imaging for dense tissue or medical need. Cost-sharing exceptions apply.
Plans that cover a medically necessary mastectomy also cover related reconstruction, prostheses, and treatment for physical complications. If there is no evidence of cancer, coverage may be limited to two years.
Argument forPeople who need breast screening could get covered services without cost sharing, which may make recommended screening easier to afford when they follow plan rules.
Argument againstPeople who do not follow their plan’s rules for using contracted providers may face cost sharing because the no-cost rule does not apply in that situation.
More detail
Insurers provide coverage for specified breast screenings and related imaging. Group or individual policies cover Illinois residents; the policies or plans covered depend on the screening service. Mammograms are covered by age and medical need, and certain other imaging is covered for dense breast tissue or medical need. The listed screening coverage is provided at no cost and does not count toward annual or lifetime benefit limits. Diagnostic mammogram cost sharing may apply when needed to preserve health savings account eligibility. The no-cost rule does not apply when a person fails to follow plan rules for using contracted providers. Coverage for non-contracted providers must be at least as favorable as for other radiology exams. The Act takes effect January 1, 2028. Some imaging coverage applies to plans amended, delivered, issued, or renewed on or after dates specified in the law, including January 1, 2020, or the effective date of an act of the 103rd General Assembly.
Insurers that cover mastectomy surgery also cover related reconstruction and prosthetic devices. A mastectomy means removing all or part of a breast for medically necessary reasons, as determined by a licensed physician. Coverage includes reconstruction of the affected breast, surgery on the other breast to produce a similar appearance, prostheses, and treatment for physical complications such as lymphedema. The patient and attending physician decide on care together. Coverage follows the plan’s mastectomy cost-sharing and other benefit terms. When there is no evidence of cancer, coverage may be limited to services provided within two years after the mastectomy.
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Where it stands
- Introduced
- Passed House
- Passed Senate
- To Governor
- Became Law
Looking ahead
No hearings or votes scheduled.
History
- 2026
- Aug 7Public Act . . . . . . . . . 104-0783Latest
- Aug 7Effective Date January 1, 2028
- Aug 7Governor J. B. Pritzker ApprovedBecame Law
- Jun 26Sent to the GovernorTo Governor
- Jun 1Added as Alternate Co-Sponsor Sen. Mattie Hunter
- Jun 1Added as Alternate Co-Sponsor Sen. Elgie R. Sims, Jr.
- Jun 1Added as Alternate Co-Sponsor Sen. Steve Stadelman
- May 31Added as Alternate Co-Sponsor Sen. David Koehler
- May 31Added as Alternate Co-Sponsor Sen. Mary Edly-Allen
- May 31Added as Alternate Co-Sponsor Sen. Sara Feigenholtz
- May 31Added as Alternate Co-Sponsor Sen. Suzy Glowiak Hilton
- May 31Added as Alternate Co-Sponsor Sen. Robert F. Martwick
- May 31Added as Alternate Co-Sponsor Sen. Michael W. Halpin
- May 28Added Co-Sponsor Rep. Debbie Meyers-Martin
- Vote recorded Concurrence, Amendment 1. Result: pass.Lower
- May 28Added Co-Sponsor Rep. Justin Cochran
- May 28Passed Both Houses
- May 28House Concurs
- May 28Senate Floor Amendment No. 1 House Concurs 113-000-000
- May 26Senate Floor Amendment No. 1 Motion to Concur Recommends Be Adopted Insurance Committee; 015-000-000
- Vote recorded Do Pass, Amendment 1. Result: pass.Lower
- May 25Senate Floor Amendment No. 1 Motion to Concur Rules Referred to Insurance Committee
- May 22Senate Floor Amendment No. 1 Motion to Concur Referred to Rules Committee
- May 22Senate Floor Amendment No. 1 Motion Filed Concur Rep. Nabeela Syed
- May 21Placed on Calendar Order of Concurrence Senate Amendment(s) 1
- Vote recorded Third Reading. Result: pass.Upper
- May 21Arrived in HouseMinor
- May 21Third Reading - Passed; 056-000-000Passed Senate
- May 14Placed on Calendar Order of 3rd Reading May 18, 2026
- May 14Senate Floor Amendment No. 1 Adopted; GuzmanMajor
- May 14Second ReadingMinor
- May 13Added Co-Sponsor Rep. Kevin John Olickal
- May 13Senate Floor Amendment No. 1 Recommend Do Adopt Insurance; 011-000-000
- May 12Senate Floor Amendment No. 1 Assignments Refers to Insurance
- Vote recorded Do Pass, Amendment 1. Result: pass.Upper
- May 8Senate Floor Amendment No. 1 Referred to Assignments
- May 8Senate Floor Amendment No. 1 Filed with Secretary by Sen. Graciela GuzmánMinor
- May 6Placed on Calendar Order of 2nd Reading May 7, 2026Minor
- May 6Do Pass Insurance; 009-000-000
- May 5
- Vote recorded Do Pass. Result: pass.Upper
- Apr 28Assigned to InsuranceMinor
- Apr 28Alternate Chief Sponsor Changed to Sen. Graciela Guzmán
- Apr 22Added Co-Sponsor Rep. Elizabeth "Lisa" Hernandez
- Apr 21Referred to Assignments
- Apr 21First ReadingMinor
- Apr 21Chief Senate Sponsor Sen. Ram Villivalam
- Apr 21Placed on Calendar Order of First ReadingMinor
- Apr 21Arrive in SenateMinor
- Apr 17Added Chief Co-Sponsor Rep. Yolonda Morris
- Vote recorded Third Reading. Result: pass.Lower
- Apr 17Added Co-Sponsor Rep. Norma Hernandez
- Apr 17Added Co-Sponsor Rep. Michael Crawford
- Apr 17Added Co-Sponsor Rep. Kimberly Du Buclet
- Apr 17Added Co-Sponsor Rep. Lisa Davis
- Apr 17Added Co-Sponsor Rep. Sharon Chung
- Apr 17Added Co-Sponsor Rep. Sonya M. Harper
- Apr 17Added Co-Sponsor Rep. Rita Mayfield
- Apr 17Added Co-Sponsor Rep. Jawaharial Williams
- Apr 17Third Reading - Short Debate - Passed 104-000-000Passed House
- Apr 17Placed on Calendar Order of 3rd Reading - Short Debate
- Apr 17House Floor Amendment No. 2 AdoptedMajor
- Apr 17House Floor Amendment No. 1 AdoptedMajor
- Apr 15House Floor Amendment No. 2 Recommends Be Adopted Insurance Committee; 015-000-000Minor
- Vote recorded Do Pass, Amendment 2. Result: pass.Lower
- Apr 15House Floor Amendment No. 2 Rules Refers to Insurance Committee
- Apr 15House Floor Amendment No. 2 Referred to Rules Committee
- Apr 15House Floor Amendment No. 2 Filed with Clerk by Rep. Nabeela SyedMinor
- Apr 14Added Co-Sponsor Rep. Janet Yang Rohr
- Vote recorded Do Pass, Amendment 1. Result: pass.Lower
- Apr 14House Floor Amendment No. 1 Recommends Be Adopted Insurance Committee; 015-000-000Minor
- Apr 14House Floor Amendment No. 1 Rules Refers to Insurance Committee
- Apr 13House Floor Amendment No. 1 Referred to Rules Committee
- Apr 13House Floor Amendment No. 1 Filed with Clerk by Rep. Nabeela SyedMinor
- Apr 10Held on Calendar Order of Second Reading - Short DebateMinor
- Apr 10Second Reading - Short DebateMinor
- Apr 7Added Co-Sponsor Rep. Emanuel "Chris" Welch
- Mar 25Placed on Calendar 2nd Reading - Short DebateMinor
- Mar 24Do Pass / Short Debate Insurance Committee; 010-006-000
- Vote recorded Do Pass. Result: pass.Lower
- Mar 18Assigned to Insurance CommitteeMinor
- Mar 17Added Co-Sponsor Rep. Mary Gill
- Mar 13Added Co-Sponsor Rep. Suzanne M. Ness
- Mar 12Added Chief Co-Sponsor Rep. Camille Y. Lilly
- Mar 10Added Co-Sponsor Rep. Nicolle Grasse
- Mar 10Added Co-Sponsor Rep. Will Guzzardi
- Mar 6Added Chief Co-Sponsor Rep. Laura Faver Dias
- Mar 5Added Co-Sponsor Rep. Gregg Johnson
- Mar 5Added Co-Sponsor Rep. Kelly M. Cassidy
- Mar 3Added Co-Sponsor Rep. Maura Hirschauer
- Feb 24Added Chief Co-Sponsor Rep. Joyce Mason
- Feb 17Added Co-Sponsor Rep. Theresa Mah
- Feb 17Added Co-Sponsor Rep. Daniel Didech
- Feb 11Added Co-Sponsor Rep. Michelle Mussman
- Feb 10Referred to Rules Committee
- Feb 10First ReadingMinor
- Feb 4Added Co-Sponsor Rep. Katie Stuart
- Feb 4Filed with the Clerk by Rep. Nabeela SyedIntroduced
Healthcare