The Affordable Care Act (ACA) eliminated out-of-pocket costs (OOPCs) for nearly all women who undergo screening mammography. However, this mandate does not prohibit OOPCs for additional breast imaging examinations or procedures, which occur after greater than 10% of screening examinations. Because screening examinations may result in unanticipated financial consequences for patients, a new study published in JAMA Network Open examined trends in OOPCs for commercially insured women who underwent additional breast imaging evaluations or procedures after screening mammography.
Researchers performed a retrospective analysis using a national commercial claims database (OptumInsight, Eden Prairie, Minnesota) with individual-level demographic information and inpatient, outpatient, and pharmacy claims for health care plan members residing in all 50 US states. Claims information included both OOPCs for plan members (eg, deductibles, copayments, and coinsurance) and total standardized reimbursements. Researchers included women ages 40 to 64 years enrolled in employer-based health care plans between 2010 and 2017 who underwent screening mammography and additional breast imaging examinations or procedures within 11 months of the screening mammogram.
Study 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. This trend coincides with the rapid rise in high-deductible health care plans that has been observed during the same time frame as the study period. This higher cost sharing could deter women from undergoing diagnostic evaluation following screening mammography.
- Out-of-Pocket Costs of Diagnostic Breast Imaging Services After Screening Mammography Among Commercially Insured Women From 2010 to 2017. JAMA Network Open. August 17 2021