Wisconsin Gail’s Law Requires Breast Cancer Screening Coverage in 2027

Wisconsin employers and plan sponsors should prepare for new breast cancer screening coverage requirements under Gail’s Law, formally enacted as 2025 Wisconsin Act 103. Governor Tony Evers signed the law on March 19, 2026, expanding access to medically necessary diagnostic breast examinations and supplemental breast screening examinations for individuals at increased risk of breast cancer or with dense breast tissue.

The law applies to Wisconsin-issued health insurance policies, including fully insured group health plans, as well as certain governmental self-insured plans. According to the Wisconsin Office of the Commissioner of Insurance, governmental self-insured health plans, small group health plans, and individual market health insurers must comply for policy or plan years beginning January 1, 2027.

Overview of Gail’s Law

Gail’s Law was created to reduce financial barriers to follow-up breast cancer imaging, especially for individuals whose mammograms may not provide enough information due to dense breast tissue or other risk factors. The law is named in honor of Gail Zeamer, a Wisconsin advocate whose late-stage breast cancer diagnosis followed undetected cancer in dense breast tissue.

Under the new requirements, covered health plans must provide coverage for certain breast cancer screening and diagnostic services when medically necessary. This includes diagnostic breast examinations used to evaluate a suspected or detected abnormality, as well as supplemental screening examinations for individuals who are at increased risk of developing breast cancer.

Covered Breast Cancer Screening Services

Gail’s Law requires coverage for supplemental breast screening examinations for individuals who have an increased risk of breast cancer or dense breast tissue. Supplemental breast screening may include medically necessary breast MRI or breast ultrasound when no abnormality is currently seen or suspected, but additional imaging is appropriate because of personal history, family history, dense breast tissue, or other recognized risk factors.

The law also defines diagnostic breast examinations to include medically necessary imaging used to evaluate an abnormality that is seen, suspected, or detected. These examinations may include breast MRI, breast ultrasound, breast tomosynthesis, or diagnostic mammography.

Cost-Sharing Restrictions

A key feature of Gail’s Law is its limitation on patient cost-sharing. Covered plans may not impose cost-sharing for diagnostic breast examinations. In addition, plans may not apply cost-sharing to the first supplemental breast screening examination in a policy year. However, cost-sharing may apply to additional supplemental breast screening examinations performed later in the same policy year.

The law also restricts plans from applying additional exclusions, limitations, deductibles, copayments, or excessive-charge restrictions unless those same terms apply to other radiological examinations.

For individuals enrolled in high deductible health plans linked to Health Savings Accounts, plans should be reviewed carefully. If first-dollar coverage would affect HSA eligibility, the plan may need to apply the IRS minimum deductible before paying benefits.

Effective Date for Wisconsin Health Plans

Gail’s Law generally applies to policy or plan years beginning on January 1, 2027. For plans subject to a collective bargaining agreement, the requirements apply later if the agreement has not yet been newly established, extended, modified, or renewed.

Employers should review whether their plan is subject to the new mandate. Fully insured Wisconsin group health plans should coordinate with their carriers to confirm compliance. Employers sponsoring non-ERISA self-funded governmental plans should work with their third-party administrators to update plan documents and claims procedures.

Employer Compliance Considerations

Wisconsin employers should begin preparing before the 2027 plan year. Fully insured employers should confirm that insurers will incorporate the required diagnostic and supplemental breast screening coverage. Employers sponsoring applicable non-ERISA self-funded plans should review plan language, claims administration processes, and employee communications.

Self-funded and level-funded ERISA plans are generally not required to comply with Wisconsin’s state insurance mandate because ERISA preemption typically limits the application of state benefit mandates to those arrangements. However, employers with ERISA plans may still choose to voluntarily review their breast cancer screening benefits as part of broader preventive care and employee health strategies.

Key Takeaways for Employers

Gail’s Law expands breast cancer screening coverage in Wisconsin by requiring certain health plans to cover medically necessary diagnostic breast examinations and supplemental breast screening examinations. The law is especially relevant for individuals with dense breast tissue or increased breast cancer risk.

Employers with Wisconsin fully insured plans should contact their insurance carriers before the 2027 plan year. Employers with applicable governmental self-funded plans should update plan documents and coordinate with their administrators to ensure claims are handled correctly. ERISA self-funded and level-funded plans are not required to follow the Wisconsin mandate, but employers may still want to evaluate whether their current coverage supports timely access to breast cancer detection services.