Medicare Co-Pays May Curb Mammography

Jan. 23, 2008 -- Medicare co-pays may discourage women from getting mammograms.

Researchers reporting that news in tomorrow's edition of The New England Journal of Medicine suggest that Medicare plans should consider dropping the mammography co-pay.

"For effective preventive services such as mammography, exempting elderly adults from cost-sharing may be warranted," write Brown University's Amal Trivedi, MD, MPH, and colleagues.

Trivedi's team studied more than 366,000 women in their mid- to late-60s. From 2001 to 2004, the women were enrolled in any of 174 Medicare managed-care plans in 38 states.

Most of the women were enrolled in Medicare plans in which they had no co-pay for mammography. But co-payment plans became more common during the study.

The researchers tracked the percentages of women who got a routine screening mammogram every other year. Most women did get mammography, but they were more likely to do so if they didn't have to pay anything toward the cost of their mammogram.

Almost 78% of women in plans with no co-payment got mammograms, compared with 69% of those in plans with co-payments.

Among seven plans that instituted co-payments, mammography use fell 5.5% from 2002 to 2004.  But in plans that continued to have no mammogram co-pay, mammography rose by 3%.

Co-payments for mammography ranged from $12.50 to $35.

African-Americans and women with low incomes were more likely to be enrolled in plans with mammogram co-pays, but the findings applied across the board to women of all demographic groups.

It's possible that women who are more inclined to seek mammography go for plans with no mammography co-payments, note Trivedi and colleagues.