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Women's Health Homepage

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More than 20 percent of insured mammo screenings require some out-of-pocket payment

por John W. Mitchell , Senior Correspondent
Although cost-sharing for in-network mammograms was all but eliminated under the Affordable Care Act (ACA), a recent study by the Centers for Disease Control and Prevention (CDC) found that some cohorts of women who received the test in 2015 are still paying some of the costs out-of-pocket.

More than 20 percent of insured women (private, Medicaid) aged 50-64 years and those aged 65-74 years with Medicare coverage reported paying out-of-pocket costs for their most recent screening mammogram. Further, among uninsured women aged 50-64 years, nearly 40 percent reported out-of-pocket payments for screening mammography.

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The researchers said that such costs could be a barrier to finding breast cancer at an early, treatable stage. For example, the 5-year relative survival rate for women with 0 or stage 1 breast cancer is close to 100 percent, according to the American Cancer Society.

“Some previous studies have shown that when people have out-of-pocket costs for cancer screening, costs that they pay beyond any insurance payments, they may be less likely to receive recommended screening tests,” Dr. Susan Sabatino, lead author and medical officer, Division of Cancer Prevention and Control, CDC told HCB News. “Since the Affordable Care Act was implemented … We wanted to know how commonly recently screened women reported paying out-of-pocket for a mammogram after these changes.”

The study noted that such out-of-pocket payments could be a barrier for lower-income women and disproportionately impact racial minorities. Also, the authors suggested that grandfathered health plans under the ACA exempted from insurance reforms may have contributed to the percentage of out-of-pocket payments for mammography among privately insured women.

Sabatino reports the study was not able to look at the effect of differences in out-of-pocket payments on actual use of screening. She added that examining whether changes in such payments over time affect screening use is an essential next step in studying the issue.

“For women for whom cost is a barrier to receiving screening, other resources may be available to help, such as the National Breast and Cervical Cancer Early Detection Program that provides free or low-cost mammograms to low-income, uninsured and underinsured women,” said Sabatino.

Women's Health Homepage


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