ANS Expands Digital Mammography Coverage in Private Health Plans

Digital Mammography Expands Across Private Health Insurance Plans

Private health insurance plans in Brazil must cover digital mammography for patients of any age or gender, provided a doctor orders the exam, according to an update from the National Supplementary Health Agency. The rule took effect on October 1, shifting coverage away from strict age brackets that previously limited the digital procedure to women between 40 and 69 years old. The revision followed discussions within the Committee for Updating the List of Procedures and Events in Supplementary Health and Public Consultation No. 173 before the agency’s collegiate board approved it on September 3.

The policy change coincides with breast cancer awareness campaigns as the National Cancer Institute projects 78,610 new cases of the disease annually across the country between 2026 and 2028. While breast cancer primarily affects women, the removal of the prior age restriction means men and individuals outside the previous 40-to-69 window now have guaranteed access to digital mammography when a physician determines it is clinically necessary.

Clinical Advantages and Screening Protocols Remain Separate

Diagnostic imaging services gain operational alignment under the updated mandate, which introduces technology featuring lower radiation exposure and reduced breast compression time compared to conventional methods. However, the regulatory adjustment modifies coverage criteria rather than clinical screening guidelines.

Screening frequency continues to depend on individual risk assessments, personal history, and age rather than insurance eligibility alone. Diagnostic mammograms remain separate from routine screening, serving instead to investigate specific physical changes such as persistent lumps or unusual discharge.

Patients Should Seek Legal Counsel After Coverage Denials

Jamily Borba de Alcântara, a specialist in health and consumer law, stated that a doctor’s order serves as the primary justification for the procedure. If an insurer denies coverage despite a valid medical recommendation, patients should request a written justification, retain all documentation, and file a complaint with the regulatory agency or seek legal counsel.

Milva noted that expanded access must pair with high diagnostic quality and continuous care to benefit patients and prevent late-stage detection. Alongside private insurance updates, the public healthcare system provides free treatment and diagnostic services, including recently added oncological medications and specialized care within a mandated 60-day window following diagnosis.

Frequently Asked Questions About Digital Mammography Coverage

Who is eligible for digital mammography under the new insurance rule?

Any patient enrolled in a private health plan can receive coverage for a digital mammography exam regardless of age or gender, provided a licensed physician issues a medical order for the procedure.

How does the new rule affect male patients?

Men are now explicitly included in the mandatory coverage mandate when a doctor prescribes the exam.

What steps should a patient take if an insurance provider denies the digital mammography scan?

Jamily Borba de Alcântara advises patients facing a denial to request a written explanation from the insurer, keep all medical records and protocol numbers, and report the refusal to the regulatory agency or pursue legal guidance.

Pink October: Outreach and Prevention Discussions in Manaus

On October 22, the Instituto Municipal de Planejamento Urbano (Implurb) in Manaus hosted an Outubro Rosa lecture addressing breast and cervical cancer prevention, vaccination against HPV, and emotional support during treatment. Psychologist Magaly Oliveira led the session, emphasizing the importance of emotional backing for both patients and their families. Participants and staff, including Tânia Cabral, Raimunda Frazão, and Roberta Evangelista, discussed the value of regular preventive exams, body awareness, and sharing personal family experiences with cancer during the event.