Does HealthCare reform mandate coverage of prophylactic mastectomy and reconstruction when indicated (ie, BRCA1/2 positive mutation, family/personal hx of breast cancer, etc) and does it cover diagnostic procedure of digital breast tomosynthesis procedures as well? If you are not able to answer this, please advise where to locate this information, since I have made several calls to local exchanges, but they are more business than clinical.


The ACA does not require coverage of prophylactic mastectomy or reconstruction procedures, but some state laws do. Thus it will be plan specific and state specific. Typically an insurer will cover it if it is deemed "medically necessary".

Your best bet will be to call the insurer directly, explain where you live and other details, and then find out if they offer a plan in your region that provides coverage with cost sharing.

By going on AETNA's website we can see that they cover the treatments in specific situations as of July 2015.

We have seen BCBS plans cover this as well. Here is a writeup on BCBS plan coverage of Prophylactic procedures Alabama that lays-out what sort of coverage it provides. Alabama isn't the most progressive state insurance-wise, so it's a good sign they provide coverage in at least some situations.

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