ACA Requires Mammogram Coverage at 40: Pros & Cons | Mercer US

ACA Requires Mammogram Coverage at 40: Pros & Cons

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ACA Requires Mammogram Coverage at 40 For Now
Calendar24 April 2015

The US Preventive Services Task Force (USPSTF) issued draft advice on Monday recommending that women ages 50–74 get a mammogram every two years. Citing concerns about the risks associated with false positives, the USPSTF recommends women in their 40s make individual decisions after consulting with their physicians. This draft is mostly a restatement of the USPSTF 2009 recommendation but it remains at odds with the 2002 recommendation regulators used to define a “recommended preventive service” that non-grandfathered health plans must cover with no cost sharing. For purposes of the ACA, the current breast cancer screening recommendation allows mammography for women age 40 years and older, with or without clinical breast examination, every one to two years. It’s unclear if this new recommendation will result in a change to the ACA rule. Keep an eye out for any developments, and be prepared to consider the pros and cons of a plan design change should the ACA rule change.


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