Interventions to reduce cost barriers still needed for some women seeking mammograms

There may still be a need for programs and interventions designed to reduce or eliminate cost barriers for some women who receive breast screening mammograms, according to new research published in the Journal of Women’s Health. Almost 40 percent of uninsured women aged 50-64 years old, for instance, reported paying out-of-pocket costs for their most recent mammogram. 

“Because cost may be a barrier to receiving mammography screening, cost sharing for ‘in-network' screening mammograms was eliminated in many insurance plans with implementation of the Affordable Care Act (ACA),” wrote lead author Susan A. Sabatino, MD, MPH, of the Division of Cancer Prevention and Control at the Centers for Disease Control and Prevention in Atlanta, and colleagues. 

Sabatino and colleagues noted a mixed bag of opinions related to cost sharing having an impact mammography use. They examined the incidence of out-of-pocket payments for screening mammography after many health insurance plans eliminated cost sharing after implementation of the ACA.

The authors determined which women aged 50-74 had a mammogram within the previous year and whether they paid out-of-pocket using data from the 2015 National Health Interview Survey. Data was further stratified by two age groups, demographics and insurance type.

Overall, they found that 77 percent of women aged 50-64 and 88 percent of women aged 65-74 reported having a screening mammogram, with no out-of-pocket costs.

“The fact that most women reported having no out-of-pocket payments for mammograms is not surprising,” Sabatino et al. wrote. The researchers attributed this to increases in insurance coverage and insurance reforms that curtail cost barriers for some preventive services among people with insurance coverage.

Approximately 24 percent of women aged 50-64 reported paying out-of-pocket costs. Almost 40 percent of uninsured women in the same age group reported out-of-pocket payments. Compared to women with private insurance, out-of-pocket payments were less likely for women with Medicaid or other insurance and more likely for the uninsured population.

For women aged 65-74, approximately 12 percent reported payment, including 23 percent of individuals insured with only Medicare. Compared to women with private insurance, out-of-pocket payments were less likely for Medicare/Medicaid beneficiaries and more likely for those insured with only Medicare.

“Prevalent out-of-pocket payments among uninsured women, together with their under-representation in this sample of screened women, may indicate an ongoing need for programs and interventions designed to reduce or eliminate cost barriers for this group,” the authors concluded. “Continued efforts are needed to monitor cost sharing and to assess the impact of changes in cost sharing on screening use and disparities.”