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Will your insurance company still cover annual mammograms at age 40? So far, most say yes

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There are a lot of worries surrounding this week’s new breast screening guidelines from the U.S. Preventive Services Task Force. Women and their doctors must now decide whether to follow the old recommendations, for annual mammograms after age 40, or the new ones, which call for mammograms to begin at 50 and to take place just every other year.

And what if they choose the old guidelines? Will their insurance companies still cover the cost of annual exams? Will the decade of mammograms between age 40 and 50 be paid for, or will they become out-of-pocket costs for women patients who choose to have them?

So far, so good. USA Today interviewed several of the country’s biggest health insurance companies, all of whom said they would continue to pay for annual mammograms beginning at age 40. Some of the companies interviewed were Kaiser Permanente, Aetna, Cigna, Geisinger Health Plan, Group Health Cooperative and WellPoint, which operates Blue Cross/Blue Shield plans in 14 states.

Nationwide, these plans cover more than 73 million people.

From the USA Today story:
“A spokeswoman for Kaiser Permanente, Farra Levin, says, "We believe that focusing on prevention and early detection is critical in improving women's health and saving lives."

“That doesn't mean that companies are totally ignoring the task force's advice.

“A spokeswoman for WellPoint, Jill Becher, says the company considers the task force's recommendations, but also weighs advice from the American Cancer Society and American College of Obstetrics and Gynecology, which still recommend annual screenings beginning at age 40.

“Group Health Cooperative, among others, plans to look at the task force's recommendations next year, says spokesman Michael Foley, but it would still pay for the screening.”

Secretary of Health and Human Services Kathleen Sebelius has said that government support for annual mammograms after 40 is not changing. Medicare will still pay for one mammogram for women between the ages of 35 to 39 and annual screenings after that.

But it’s clear that there could be changes in this arena.

At what age should women start receiving mammograms?
Younger than 40
48% (63 votes)
40 to 49
39% (51 votes)
50 and older
14% (18 votes)
Total: 132 Votes

Add a Comment3 Comments


Your point is so very, very important. Women who feel strongly about this issue have to be heard. It's important to talk among ourselves, with our moms, our sisters, our daughters, our friends. But it's also important to talk to our doctors, and, when the issue gets really political, to make sure our senators and representatives know where we stand.

When these recommendations on mammograms came out, despite the fact that they were so roundly criticized by patients, doctors and cancer experts, I could almost hear the calculators totaling up the "savings" to insurance companies if these recommendations were adopted as the norm. I only hope that the medical minds -- not the business or political minds -- are the ones who prevail here.

Thanks so much for writing.

November 23, 2009 - 8:25am
Expert HERWriter Guide Blogger

Hi Diane - Thanks for providing this comprehensive look at the response to the suggested breast cancer screening guidelines.
An important point to keep in mind is that most health insurance plans operate on a contractual basis that specifies whether or not the plan will cover specific services. The agreed upon services are still in force and are not affected by the new guidelines.
It has taken significant lobbying to get many plans to include and/or maintain mammography as a covered service. Those who have strong feelings about what should be covered, and when it should be covered, may want to review their insurance plans to clarify the specific coverages, and then discuss the matter with those responsible for the benefit plans in their companies or their state legislators if covered by a Medicaid program.
It's going to be up to women to make their voices heard on what services we need for our own best health. It's sad to hear so many politicians trying to turn this into a political issue and point fingers. The real need is to prevent, detect and treat breast cancer in the best way possible for the benefit of the women, and men, who get this disease.
Best Regards,

November 19, 2009 - 5:46pm

I really think it is bad advise, bad research, bad medicine to not have mams before 50. Many women are reluctant or don't have insurance and this may be one more reason to delay. Not good at all!

November 19, 2009 - 5:36pm
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We value and respect our HERWriters' experiences, but everyone is different. Many of our writers are speaking from personal experience, and what's worked for them may not work for you. Their articles are not a substitute for medical advice, although we hope you can gain knowledge from their insight.

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