Bottom Line: Mammograms are Still Covered
Ed. note: This blog is cross-posted from the HHS.gov blog. The original post date was January 11, 2016. Read the original post.
Recently, several organizations have updated breast cancer screening recommendations, including the U.S. Preventive Services Task Force (USPSTF), which released its evaluation today.
The various screening recommendations may cause confusion among women about whether or not a mammogram is covered by their health insurance. I want to make clear that coverage requirements for mammograms have not changed.
The Affordable Care Act improved access to health care, including preventive services, for millions of Americans. Today, most health insurance plans are required to cover many preventive services at no out-of-pocket cost to the consumer, including breast cancer screening. Coverage of preventive services improves access to affordable, quality health care, prevents serious health conditions before they start, and empowers women to obtain better care for their health. Specifically, coverage of preventive services without copays increases the likelihood that low-income and minority women receive these important health care services, such as mammography.
Now, without worry about whether they can afford it, American women can make informed decisions about mammography based on science. The updated USPSTF recommendations emphasize the benefits of mammography screening for all women between the ages of 50–74 years; screening can also be beneficial for women in their 40s, but there may be downsides that they should consider. The USPSTF encourages women ages 40–49 to discuss with their doctors the risks and benefits of mammography screening and then make informed decisions that take into account their own values and situations. As with all USPSTF recommendations, the breast cancer screening recommendations will be reevaluated as more science becomes available to better determine the risks and benefits of screening.
This USPSTF recommendation won't impact coverage requirements. Here's why:
In December, the President signed a bill that ensures that women's coverage for mammography will remain the same through 2017. Women 40 years and older enrolled in most health insurance plans will continue to be covered for screening mammography every 1–2 years without copays, coinsurance, or deductibles — just as they are today. If a woman 40 years and older and her doctor determine that a mammogram is appropriate, she will not have to pay out of pocket.
As a cancer control specialist, I have spent many years promoting the benefits of breast cancer screening, which can find cancers early when treatment is most likely to be successful. I encourage women to learn about the many preventive services that are available to them at no cost, from mammograms to smoking cessation programs to cholesterol screening. Visit myhealthfinder to see which preventive services you or a loved one may need this year.