Mammogram Use Increases After ACA Cost-Sharing Eliminated


The rate of mammogram use increased by nearly 6% among older patients who were recommended for screening after the Affordable Care Act (ACA) eliminated co-payments.

Prior research has shown that age-appropriate (age 50 to 74 years) screening mammography is cost-effective and reduces breast cancer-related mortality. However, the formally required co-payments for preventive services such as mammograms reduced the number of women who received this care. Co-payments as low as $20 have been shown to decrease the rate of breast cancer screening by up to 11%.

Amal N Trivedi, MD, MPH, associate professor of health services, Brown University, and colleagues conducted a difference-in-differences study of biennial screening mammography among 15,085 patients aged 65 to 74 years in 24 Medicare Advantage plans that eliminated cost-sharing to provide full coverage of screening mammography. The data were compared to that of 52,035 patients in 48 matched control plans that had maintained full coverage.

Results of the study were published in The New England Journal of Medicine (January 2018;378:262-269).

Researchers found that in the plans that eliminated cost-sharing, adjusted rates of biennial screening mammography increased from 59% (95% CI, 54.9-65.0) in the 2-year period before cost-sharing elimination to 65.4% (95% CI, 61.8-69.0) in the 2-year period thereafter. In the control plans, the rates were 73.1% and 72.8%, respectively, yielding a difference in differences of 5.7 percentage points (95% CI, 3.0-8.4).

Further analysis revealed that these gains were concentrated among patients in the highest quartile of educational attainment, white race, and black race. These gains were unchanged for Hispanic women.


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Dr Trivedi and colleagues concluded that the elimination of cost-sharing for screening mammography under the ACA was associated with an increase in screening use among older patients for whom screening is recommended.

“We have work to do when it comes to women with less education and Hispanic women,” Dr Trivedi commented in an interview with EurekAlert (January 17, 2018). “They need to be better aware of the cost-sharing provisions of the ACA.”—Zachary Bessette