title: Screening Mammography for Free: Impact of Eliminating Cost Sharing on Cancer Screening Rates.
abstract: To study the impact of eliminating cost sharing for screening mammography on mammography rates in a large Medicare Advantage (MA) health plan which in 2010 eliminated cost sharing in anticipation of the Affordable Care Act mandate.
  
  
  
  Large MA health maintenance organization offering individual-subscriber MA insurance and employer-supplemented group MA insurance.
  
  
  
  We investigated the impact on breast cancer screening of a policy that eliminated a $20 copayment for screening mammography in 2010 among 53,188 women continuously enrolled from 2007 to 2012 in an individual-subscriber MA plan, compared with 42,473 women with employer-supplemented group MA insurance in the same health maintenance organization who had full screening coverage during this period. We used differences-in-differences analysis to study the impact of cost-sharing elimination on mammography rates.
  
  
  
  Annual screening rates declined over time for both groups, with similar trends pre-2010 and a slower decline after 2010 among women whose copayments were eliminated. Among women aged 65-74 years in the individual-subscriber MA plan, 44.9 percent received screening in 2009 compared with 40.9 percent in 2012, while 49.5 percent of women in the employer-supplemented MA plan received screening in 2009 compared with 44.1 percent in 2012, that is, a difference-in-difference effect of 1.4 percentage points less decline in screening among women experiencing the cost-sharing elimination. Effects were concentrated among women without recent screening. There were no differences by neighborhood socioeconomic status or race/ethnicity.
  
  
  
  Eliminating cost sharing for screening mammography was associated with modesty lower decline in screening rates among women with previously low screening adherence.
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA.
authors.forename: Anupam B
authors.initials: AB
authors.lastname: Jena
authors.affiliation: Division of Research, Kaiser Permanente, Oakland, CA.
authors.forename: Jie
authors.initials: J
authors.lastname: Huang
authors.affiliation: Division of Research, Kaiser Permanente, Oakland, CA.
authors.forename: Bruce
authors.initials: B
authors.lastname: Fireman
authors.affiliation: Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA.
authors.forename: Vicki
authors.initials: V
authors.lastname: Fung
authors.affiliation: Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA.
authors.forename: Scott
authors.initials: S
authors.lastname: Gazelle
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA.
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Landrum
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA.
authors.forename: Michael
authors.initials: M
authors.lastname: Chernew
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Newhouse
authors.affiliation: Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA.
authors.forename: John
authors.initials: J
authors.lastname: Hsu
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging; D017047:Cost Sharing; D055088:Early Detection of Cancer / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D019458:Insurance Coverage / Q000191:economics / Q000706:statistics & numerical data; D008327:Mammography / Q000191:economics / Q000706:statistics & numerical data*; D006278:Medicare / Q000191:economics / Q000458:organization & administration; D014481:United States
keywords: Affordable Care Act; Cost sharing; mammography