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Would you share how The Patient Protection and Affordable Care Act (ACA) will effect women under 40 years old who should be receiving mammograms?
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member6552 (Organization (Verified) ) - 06 / 21 / 2012
Insurance coverage for screening mammograms for breast cancer varies by state and by type of insurance coverage (private insurance, Medicare, Medicaid). Most states require private insurance companies to provide screening mammograms to women over the age of 40 on an annual basis. Some states also provide coverage to women under 40 who may be at high risk for breast cancer. You can check with your state’s insurance agency for more information about the laws in your state.
The Patient Protection and Affordable Care Act (ACA) does not change these state law protections. However, the ACA does require any new health insurance plans to offer free preventative care, including mammograms. This provision does not apply to grandfathered plans, meaning plans that were in existence at the time the ACA was signed into law on March 23, 2010. Plans may lose their grandfathered status at any time, if they make a substantial change to the plan.
“Free” means that not only will the insurance plan cover the mammogram, but they cannot apply any costs to your deductible, or charge you a co-pay or co-insurance amount. There is a specific list of preventative services to which this new provision applies, which can be found athttp://www.HealthCare.gov. Even if your plan in self-insured, this new provision may apply to you.
For women who are under the age of 40 and who may be at high risk for breast cancer, it is still important to talk to your healthcare team about documenting the high risk status and explaining in the medical record the need for screening at a younger age. This will improve your chances of getting your insurance company to pay for the screening. You can also appeal any insurance denials. If you, or someone you know, is over 40 and has a low income, and is uninsured or underinsured, check out the National Breast and Cervical Early Detection Program athttp://www.cdc.gov/cancer/nbccedp/. If you, or someone you know, is under 40 and is uninsured or underinsured, many Susan G. Komen for the Cure® Affiliates provide grants in their communities to provide screening for women under 40. You can find your local Komen Affiliate at www.komen.org.
The Patient Protection and Affordable Care Act (ACA) does not change these state law protections. However, the ACA does require any new health insurance plans to offer free preventative care, including mammograms. This provision does not apply to grandfathered plans, meaning plans that were in existence at the time the ACA was signed into law on March 23, 2010. Plans may lose their grandfathered status at any time, if they make a substantial change to the plan.
“Free” means that not only will the insurance plan cover the mammogram, but they cannot apply any costs to your deductible, or charge you a co-pay or co-insurance amount. There is a specific list of preventative services to which this new provision applies, which can be found athttp://www.HealthCare.gov. Even if your plan in self-insured, this new provision may apply to you.
For women who are under the age of 40 and who may be at high risk for breast cancer, it is still important to talk to your healthcare team about documenting the high risk status and explaining in the medical record the need for screening at a younger age. This will improve your chances of getting your insurance company to pay for the screening. You can also appeal any insurance denials. If you, or someone you know, is over 40 and has a low income, and is uninsured or underinsured, check out the National Breast and Cervical Early Detection Program athttp://www.cdc.gov/cancer/nbccedp/. If you, or someone you know, is under 40 and is uninsured or underinsured, many Susan G. Komen for the Cure® Affiliates provide grants in their communities to provide screening for women under 40. You can find your local Komen Affiliate at www.komen.org.
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