The United States Preventive Services Task Force (USPSTF) confirmed on January 11,
2016, their recommendations, which state that women should have their initial
mammogram starting at age 50 and every other year from age 50 to 74.
According to national leaders in breast screening, these recommendations will have no
meaningful impact on a woman’s access to screening mammograms because recent
enacted legislation included language from the Protecting Access to Lifesaving
Screenings Act (PALS Act) mandating a two-year moratorium on implementation of any
USPSTF recommendations. The Consolidated Appropriations Act, 2016 signed into law
in December assures mandatory mammography insurance coverage for millions of
women nationwide and help providers continue to save tens of thousands of lives each
year.
The Affordable Care Act (ACA) requires private insurers to cover exams or procedures
given a grade of “B” or higher by the USPSTF. The Task Force gave routine screening
of women ages 40–49 a grade of “C” and gave a “B” grade only to biennial (every other
year) screening for women 50–74. This would indicate that women ages 40–49 who
choose routine screening and those 50–74 who want to be screened annually would not
be guaranteed coverage by payers if these draft recommendations were implemented.
The protections in the Consolidated Appropriations Act allow women age 40 and older
who choose to get an annual screening mammogram to be covered, with no copay, for
these lifesaving exams. The Act also allows time for breast cancer experts to properly
vet the USPSTF recommendations, as well as vetting more recent literature on
mammography screening.
MOST IMPORANTLY: The Consolidated Appropriations Act prohibits any final
USPSTF recommendations from being implemented by health plans. This means that
most health plans will be required to continue to cover screening mammography in
accordance with the 2002 final recommendations – the only exception is those that are
still grandfathered in. Medicare’s waiver of cost-sharing for screening mammography
will remain unchanged.
We join with the Society of Breast Imaging in insisting that we must stop the
confusion! See the video here. Women Matter! Let your voice be heard!
Supporting documentation:
