On March 19, 2026, Wisconsin Governor Evers signed 2025 Wisconsin Act 103, also known as Gail’s Law, requiring health insurance policies issued in Wisconsin and self-insured plans sponsored by Wisconsin governmental entities to provide additional coverage for breast cancer screenings.

Effective for policy or plan years beginning on or after January 1, 2027, Wisconsin insurance policies and self-insured governmental plans must fully cover medically necessary supplemental breast screenings or diagnostic breast examinations for individuals at higher risk of breast cancer or have heterogeneous or extremely dense breast tissue.  Coverage is required regardless of whether breast cancer symptoms are present.

Cost sharing cannot be applied for any diagnostic breast examination or the first supplemental breast screening in a plan year. This requirement does not apply to a qualified high-deductible health plan until the minimum required deductible is met.

Important Definitions under Act 103

Act 103 defines “supplemental breast screening examination” to mean a medically necessary and appropriate examination of the breast using breast magnetic resonance imaging or breast ultrasound that is used to screen for breast cancer when there is no abnormality seen or suspected, based on personal or family medical history or additional factors that may increase an individual’s risk of breast cancer.

It also defines a “diagnostic breast examination” to mean a medically necessary and appropriate examination of the breast using breast magnetic resonance imaging, breast ultrasound, breast tomosynthesis, or diagnostic mammography that is used to evaluate any of the following:

• an abnormality seen or suspected from a screening examination for breast cancer or
• an abnormality that is detected by a health care provider or patient by another means of examination.

Breast ultrasound, breast tomosynthesis, or diagnostic mammography are further defined as:

• breast ultrasound: a noninvasive diagnostic tool that uses high-frequency sound.
• breast tomosynthesis: a procedure that uses X-rays to take a series of pictures of the inside of the breast from many different angles.
• diagnostic mammography: diagnostic tool that uses X-rays and is designed to evaluate an abnormality in the breast.

Key Takeaway

Fully insured plans subject to Wisconsin law and Wisconsin governmental entities that sponsor self-insured health plans should ensure their 2027 plan design includes the new coverage requirements under 2025 Wisconsin Act 103.