What You Need to Know About the Cost of Mammograms

Last month, Vermont directed health insurance companies to cap the out-of-pocket cost of a mammogram, setting the limit at $25.

“Studies suggest cost is a factor in whether women seek and receive mammography services,” Vermont Gov. James Douglas said. “This law is to encourage every woman to get regular mammograms.”

While Vermont’s new law is a step in the right direction, universal, affordable access is still a far-off goal .

OBOB recently looked at the risks and benefits of routine mammograms for premenopausal women in their 40s. Despite the controversy concerning mammograms for premenopausal women, the value of routine mammograms for postmenopausal women is widely accepted.

But not everyone has access to high quality mammograms and, if necessary, subsequent treatment. This month, we’re looking at the cost of mammograms, insurance co-pays and programs that provide low-income women with free mammography and breast exams.

While 80 percent of U.S. women over age 50 reported having a mammogram within the last two years (as of 2006), according to Kaiser’s State Health Facts, the percentage varies by state, with Massachusetts at the high end (87.5 percent) and Mississippi (69.7 percent) at the bottom. The states are further broken down by race and ethnicity, though there’s not always enough information available for comparison.

The average cost of a mammogram is between $50 and $150; digital mammograms cost even more. Most states now require health insurance companies to pay all or most of the cost — although for some women, the remaining co-payment amount can stand in the way of making the appointment.

Mammography screening rates remained steady until about 2003 — at that point, the rates started to decline among women aged 50 and older. “I suspect patients’ fear, lack of knowledge of efficacy, physical discomfort during the procedure, denial, geographic barriers, lack of primary care doctor and inability to pay are all factors,” Dr. Alan Sager, professor of health policy and director of the health reform program at Boston University’s School of Public Health, told ABC News earlier this year.

The drop itself may not be a concern if women are making informed decisions about their personal health and are not avoiding mammograms because of cost, said Barbara Brenner, executive director of Breast Cancer Action.

“Falling mammography rates don’t necessarily mean that the sky is falling,” Brenner told OBOB. “After all, in Europe, women are screened less frequently and at older ages, with outcomes essentially the same as we have in the United States in terms of incidence and mortality. Mammography screening has lead to a lot of overtreatment, so the question is about which are the most underserved communities in this context, and conducting targeted screening outreach to them.”

Medicare, which serves people 65 and older and some people with disabilities, pays 80 percent of the cost of an annual screening mammogram for women age 40 and older, leaving most recipients with a co-pay of approximately $10 to $30. Researchers at Brown University in Providence, R.I., looked at 366,475 women covered by 174 different Medicare managed-care plans and found women who have co-payments of more than $10 are less likely to get regular mammograms than those with more generous insurance coverage, ABC News reported.

Here’s the study abstract — and more from ABC:

Mammogram screening rates were about 8 percent lower among women who had to pay more than $10 or 10 percent of a mammogram’s cost, researchers found.

Researchers then examined health plans that once fully covered the costs of mammograms but later switched to only partial coverage. From 2002 to 2004, mammography rates decreased by 5.5 percent in seven of these plans. However, in 14 other plans that continued to offer full coverage of mammograms, screening rates for breast cancer increased by 3.4 percent.

And the number of plans requiring women to make higher co-payments are on the rise. In 2004, one out of nine women was forced to pay for at least 10 percent of the cost of a mammogram out-of-pocket.

The worst impacts were seen among minorities and patients from communities with lower income and education levels, as these patients were mostly likely to enroll in cheaper health insurance plans that require co-payments for mammography.

What about women who don’t have health insurance? At the national level, the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), a program of the Centers for Disease Control and Prevention, provides mammograms and clinical breast exams by a health professional to low-income, underinsured and underserved women. But the percentage of women reached is far from optimal.

One analysis of the 2002-2003 performance of the NBCCEDP found that:

Although the Program provided screening services to over a half-million low-income, uninsured women for mammography, it served a small percentage of those eligible. Given that in 2003 more than 2.3 million uninsured, low-income, women aged 40-64 did not receive recommended mammograms from either the Program or other sources, there remains a substantial need for services for this historically underserved population.

According to the NBCCEDP, between 8 and 11 percent of U.S. women of screening age (40 to 64) are eligible to receive services. (Women 65 and older are eligible for Medicare.) Federal guidelines establish an eligibility baseline to direct services to uninsured and underinsured women at or below 250 percent of federal poverty level. Contact information for programs in every state is available at the NBCCED website.

Some states provide subsequent funding for uninsured and underserved women to increase access to mammograms and comprehensive screening programs (including breast exams). Eligibility is determined by age and income requirements and varies by state, so it’s best to check with your state health department or your local representative’s office.

Here in Illinois, for instance, access to free mammograms and treatment, as well as clinical breast exams, pelvic exams and Pap tests, was recently extended to all women without health insurance between the ages of 35 and 64 under the Illinois Breast and Cervical Cancer Program.

“No one should have to forgo health screening because they can’t afford it. But screening is only one part of the puzzle,” said Brenner. “If a woman is diagnosed with breast cancer after a low-cost mammogram, how will she pay for her treatment? In California, a woman whose breast cancer is diagnosed after a mammogram administered through a state-run program will be treated at state expense. This isn’t the case in every state .”

Universal health care would solve the problem of women being able to afford breast cancer screening and treatment, adds Brenner.

“I’ve had breast cancer twice, missed in both cases by mammograms. I know how devastating this disease is. But the reality is that this isn’t just about mammography and breast cancer. We shouldn’t have to fight for health care and coverage disease by disease, body part by body part. Everyone should be able to get the care they need — whether it’s screening or treatment — regardless of the health concern.”