What to Know About Gail’s Law
- Gail’s Law (2025 WI Act 103) will go into effect July 1, 2026, for plan years that begin January 1, 2027.
- If you received a letter following a mammogram that indicates you have heterogeneously dense breast tissue, or if you have a strong family history of breast cancer, have a discussion with your provider about supplemental screening with MRI or ultrasound.
- If your provider recommends that you get an MRI or ultrasound, the provider will refer you for the test. You cannot schedule these tests on your own.
- If you receive a call back after your annual screening mammogram for further tests that would be considered diagnostic tests, you should not have to pay out of pocket for those any longer.
- Before scheduling any additional screening or diagnostic tests, follow up with your insurance plan to be sure they will comply with Gail’s Law and provide these tests cost free. They should not be applied towards your deductible and you should have no out-of-pocket costs.
What Does Gail’s Law Do?
Gail’s Law requires Wisconsin health insurance plans—including Medicaid—to cover medically necessary breast imaging for people at increased risk of breast cancer and/or with heterogeneously/extremely dense breasts.
Coverage Includes:
- Supplemental screening, such as breast MRI or ultrasound, when no abnormality is yet detected, but the risk is elevated.
- Diagnostic imaging such as MRI, ultrasound, 3D mammography (tomosynthesis), and diagnostic mammograms to evaluate abnormalities found on screening or physical exam.
- Coverage applies even if a woman has no symptoms of breast cancer.
Cost Protection – NO COST SHARING!
- No out-of-pocket costs for diagnostic breast exams
- No out-of-pocket costs for the first supplemental screening exam each policy year.
- Additional supplemental screenings in the same year may have cost-sharing.
Examinations Clarified:
- Supplemental breast screening examinations to include the use of breast MRIs or breast ultrasound to screen for breast cancer when there is no abnormality seen or suspected based on personal or family medical history.
- Diagnostic breast examinations to include the use of breast MRIs, breast ultrasounds, breast tomosynthesis, and diagnostic mammography are used to evaluate an abnormality seen or suspected from a screening examination for breast cancer or an abnormality detected through another means of examination.
When Does the Bill Take Effect?
- The bill takes effect on the first day of the fourth month beginning after publication, for Medicaid members [July 1, 2026].
- The bill would first apply to policy or plan years beginning on January 1 of the year following the year in which the act takes effect [January 1, 2027]. Check with your healthcare plan.
- If a policy or plan is affected by a collective bargaining agreement, the bill would first apply to policy or plan years beginning on the effective date of the act or on the day on which the collective bargaining agreement is newly established, extended, modified, or renewed, whichever is later.
Source: State of Wisconsin Bulletin from the Office of Governor Evers, March 19, 2026