Breast cancer screens between the ages of 50-75 can reduce cancer deaths by 26%, and can-cer spread to other tissues by 29% (CDC 2022).
Several American medical societies recommend breast exams for the preventative detection of cancer by age 40, and exams every 1-2 years thereafter (Drukteinis 2014).
The cost for secondary screens can depend on the type of insurance; plans can collect costs upfront (higher deductibles), distribute costs to consumers by usage (higher coinsurance or copays), or a combination of the above.
Table 1. Average out-of-pocket costs for non-invasive breast cancer screens in the U.S.
Patients usually have one option for an employer-sponsored insurance plan, which determines their copay and deductible costs.
Roughly 16% of women on private insurance reported paying some out-of-pocket cost for a secondary mammogram, while 11% of uninsured women and 3% of Medicaid insured reported the same (KFF 2019).
16 states (including MO) and D.C. require insurance coverage for “any additional or imaging...deemed medically necessary” (RSMo 376.782), but allows insurers to charge copays, coinsurance, or deductibles for these services.
It is not clear how state policies that prohibit out-of-pocket patient costs for breast cancer screens affect overall private insurance costs.
In the Medicare Advantage plan, eliminating copays for biennial mammography increased the screening rate by 6% (Trivedi 2018).
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Coverage of Breast Cancer Screening and Prevention Services. (2019). Kaiser Family Foundation. Retrieved from https://www.kff.org/womens-health-policy/fact-sheet/coverage-of-breast-cancer-screening-and-prevention-services/
Drukteinis, J. S., Mooney, B. P., Flowers, C. I., & Gatenby, R. A. (2013). Beyond mammography: new frontiers in breast cancer screening. American Journal of Medicine, 126(6), 472-479. doi:10.1016/j.amjmed.2012.11.025
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Health and Economic Benefits of Breast Cancer Interventions. (2022). Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/chronicdisease/programs-impact/pop/breast-cancer.htm
Hollingsworth, A. B. (2019). Redefining the sensitivity of screening mammography: A review. American Journal of Surgery, 218(2), 411-418. doi:10.1016/j.amjsurg.2019.01.039
Hughes, D. R., Espinoza, W., Fein, S., Rula, E. Y., & McGinty, G. (2023). Patient Cost-Sharing and Utilization of Breast Cancer Diagnostic Imaging by Patients Undergoing Subsequent Testing After a Screening Mammogram. JAMA network open, 6(3), e234893-e234893. doi:10.1001/jamanetworkopen.2023.4893
Kunst, N., Long, J. B., Xu, X., Busch, S. H., Kyanko, K. A., Richman, I. B., & Gross, C. P. (2020). Use and Costs of Breast Cancer Screening for Women in Their 40s in a US Population With Private Insurance. JAMA Internal Medicine, 180(5), 799-801. doi:10.1001/jamainternmed.2020.0262
Lee, B., Gerencher, K. (2022). Do Copays Count Toward Deductibles? Here’s How Health Plans Work. GoodRx Health. Retrieved from https://www.goodrx.com/insurance/health-insurance/health-insurance-premiums-deductibles-copays-co-insurance
Roganovic, D., Djilas, D., Vujnovic, S., Pavic, D., & Stojanov, D. (2015). Breast MRI, digital mammography and breast tomosynthesis: comparison of three methods for early detection of breast cancer. Bosnian Journal of Basic Medical Sciences. Udruzenje Basicnih Mediciniskih Znanosti, 15(4), 64-68. doi:10.17305/bjbms.2015.616
Sabik, L. M., Vichare, A. M., Dahman, B., & Bradley, C. J. (2020). Co-payment policies and breast and cervical cancer screening in Medicaid. American Journal of Managed Care, 26(2), 69-74. doi:10.37765/ajmc.2020.42395
State Legislation Map. (2023). Dense Breast-Info. Retrieved from https://densebreast-info.org/legislative-information/state-legislation-map/
Trivedi, A. N., Leyva, B., Lee, Y., Panagiotou, O. A., & Dahabreh, I. J. (2018). Elimination of Cost Sharing for Screening Mammography in Medicare Advantage Plans. New England Journal of Medicine, 378(3), 262-269. doi:10.1056/NEJMsa1706808
Women’s Preventive Services Guidelines. (2022). Health Resources and Services Administration. Retrieved from https://www.hrsa.gov/womens-guidelines#:~:text=Under%20the%20ACA%2C%20most%20private,services%20%E2%80%93with%20no%20cost%20sharing.