Out-of-pocket costs climbing for imaging services after mammography, despite ACA safeguards
Out-of-pocket costs for diagnostic imaging services after screening mammography are rising, despite consumer protections established by the Affordable Care Act.
The landmark 2010 legislation abolished such patient payouts for most women undergoing regular screening. But it does not ban out-of-pocket billing for other related services such as biopsies or ultrasound, which are required after more than 10% of exams, experts wrote Tuesday in JAMA Network Open.
Examining screening trends across a national commercial claims database, researchers found substantial variation in what women are paying for preventive breast care.
“Although the ACA largely eliminated [out-of-pocket costs] for screening mammography, our findings suggest that among commercially insured women ages 40 to 64 years, OOPCs for additional breast imaging evaluations and procedures after screening are common, nontrivial and increasing,” radiologist Kathryn Lowry, MD, with the Seattle Cancer Alliance, and colleagues wrote in a research letter published Aug. 17.
The lead author and co-investigators with Michigan Medicine tapped the Optum Insight database, which includes commercial plan members from all 50 states, for their analysis. They pinpointed women who underwent screening mammography and any additional imaging or procedures between 2010-2017, landing on a final study group of nearly 326,000 women and 418,000 services.
Median out-of-pocket payments for screening and diagnostic mammography, coupled with ultrasound, leapt from $0 in 2010 up to $23.44 in 2010, Lowry et al. found. All pathways incorporating MRI climbed from $24.49 up to $47.50, while women who received a breast biopsy spent more than those who did not. Cost-sharing increased across the study period, from 0% at the start up to 7.5% in 2017 for those receiving both types of mammograms and an ultrasound, and nearly doubling for women receiving a biopsy (9.6% up to 18.2%).
Lowry and co-authors are concerned these trends could push women to skip crucial follow-up exams to avoid such payouts.
“It is possible that higher cost sharing could deter women from undergoing diagnostic evaluation following screening mammography, thus undermining the goal of the ACA to remove barriers to screening,” they advised. “The benefit design of healthcare plans must acknowledge that cancer screening often requires multiple steps and remove financial barriers for patients to complete the screening process.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.