Like other types of cancer, early detection is one of the most important factors in successfully fighting breast cancer.
Now, mammographies are available through most private health plans without requiring a co-pay, co-insurance or other type of cost-sharing. This change, which effects insurance policies renewing on or after August 2012, was made under the Affordable Care Act, also known as Obamacare, which was signed into law in 2010.
This new insurance change is significant because studies show copays – even moderate copays – for mammograms and Pap smears are enough to deter women from obtaining these screenings, according to the U.S. Department of Health and Human Services.
In Wisconsin, it seems most health insurance plans already covered mammography and other preventive cancer screenings. Of the 12 health insurance providers represented by the Wisconsin Association of Health Plans, very few major benefit packages required co-payment on behalf of the patient, said Phil Dougherty, the organization's senior executive officer.
“Preventive services should be offered with zero cost-sharing so there is no barrier whatsoever to accessing these services,” Daugherty said.
However, some larger companies that offer their own insurance benefits were previously requiring their patients to pay for mammographies, according to Terrence Frett, the president of Frett Barrington Ltd., a health insurance consulting firm based in Pewaukee.
That’s significant because 60 percent of people who receive health insurance through their employer are through these larger, self-insured companies, according to a study conducted by the Office of the Commissioner of Insurance.
"The primary change is uniformity of coverage," Frett said. "It doesn’t matter if it’s a large employer providing their own benefits or a small company purchasing health care from United Healthcare, for example. Now, there is some consistency of the same preventive services to be covered, as outlined by the government."
It's still a little early to determine if free mammography coverage is changing the number of people that are going to their doctor for a breast cancer screening. Frett said he sees this aspect of the Affordable Care Act as a positive change, and he hopes it lowers any barriers that may be stopping people from seeking preventive cancer screenings.
“I wish people would take the initiative to seek out these preventive care services. That’s the challenge we continue to face," Frett said. "We can cover screenings all we want, but if people don’t take the initiative to go to the doctor’s office then it doesn’t help anything.”
Other preventive women's services covered by Obamacare include:
- Well-woman visits
- Screening for gestational diabetes, which help protect the mother and her child from one of the most serious pregnancy-related diseases
- Breastfeeding support, supplies and counseling
- Screening and counseling for interpersonal and domestic violence
- Contraception and contraceptive counseling
- HPV DNA testing
- STI counseling
- HIV screening and counseling