Elimination of Cost Sharing for Screening Mammography in Medicare Advantage Plans

Abstract

BACKGROUND The Affordable Care Act (ACA) required most insurers and the Medicare program to eliminate cost sharing for screening mammography. METHODS We conducted a difference-in-differences study of biennial screening mammography among 15,085 women 65 to 74 years of age in 24 Medicare Advantage plans that eliminated cost sharing to provide full coverage for screening mammography, as compared with 52,035 women in 48 matched control plans that had and maintained full coverage. RESULTS In plans that eliminated cost sharing, adjusted rates of biennial screening mammography increased from 59.9% (95% confidence interval [CI], 54.9 to 65.0) in the 2-year period before cost-sharing elimination to 65.4% (95% CI, 61.8 to 69.0) in the 2-year period thereafter. In control plans, the rates of biennial mammography were 73.1% (95% CI, 69.2 to 77.0) and 72.8% (95% CI, 69.7 to 76.0) during the same periods, yielding a difference in differences of 5.7 percentage points (95% CI, 3.0 to 8.4). The difference in differences was 9.8 percentage points (95% CI, 4.5 to 15.2) among women living in the areas with the highest quartile of educational attainment versus 4.3 percentage points (95% CI, 0.2 to 8.4) among women in the lowest quartile. As indicated by the difference-in-differences estimates, after the elimination of cost sharing, the rate of biennial mammography increased by 6.5 percentage points (95% CI, 3.7 to 9.4) for white women and 8.4 percentage points (95% CI, 2.5 to 14.4) for black women but was almost unchanged for Hispanic women (0.4 percentage points; 95% CI, −7.3 to 8.1). CONCLUSIONS The elimination of cost sharing for screening mammography under the ACA was associated with an increase in rates of use of this service among older women for whom screening is recommended. The effect was attenuated among women living in areas with lower educational attainment and was negligible among Hispanic women. (Funded by the National Institute on Aging.)

Breast Screening Utilization and Cost Sharing Among Employed Insured Women After the Affordable Care Act

“…Our study among others demonstrate that ACA cost share elimination did not result in increased screening rates unlike much earlier efforts to reduce financial barriers to preventive services, likely due to the high proportion of employerinsured women who already had screening cost share eliminated prior to the ACA implementation. Our results are consistent with Trivedi et al who reported no increase in screening adherence in plans already had full coverage for screening mammography during the study duration 20 .…”

The effect of the Affordable Care Act on patient out-of-pocket cost and use of preventive cancer screenings in Massachusetts

“…Previous studies of the impact of the ACA no cost policy on colorectal cancer screening and mammography have found positive effects among the Medicare population (Hamman and Kapinos, 2015; Sabatino et al, 2016; Wan et al, 2015; Jena et al, 2017; Trivedi et al, 2018), but mixed or null results among the commercially insured (Fedewa et al, 2015; Richman et al, 2015; Han et al, 2015; Mehta et al, 2015). The single previous study that included cervical cancer screenings is consistent with our finding of no result (Han et al, 2015).…”

Access to Care as a Barrier to Mammography for Black Women

“…Despite changes to health care policy that provide more expansive access to insurance, women of color continue to experience inequitable health outcomes. For example, health care reform through the ACA played a pivotal role in reducing financial impediments to accessing mammography (Fazeli Dehkordy et al., 2019; Trivedi et al., 2018); yet, barriers to mammography persist. Despite interventions such as mobile mammography vans that bring physical access to communities (Stanley et al., 2017), Black women continue to lag behind in mammography screening.…”