Your odds of long-term survival drop to 25% if your doctor finds your breast cancer late, when it has spread outside your breast. So it's worth your time to take advantage of these breast cancer prevention measures that are free under the Affordable Care Act.
When Are Mammograms Free?
You can get a free mammogram every 1 to 2 years if you're over age 40.
Can I make an appointment for just the free screening ?
Some mammography centers may require a prescription from your primary care physician or OB/GYN. You can ask for a prescription at your annual check up.
Can anyone get a free mammogram at any time?
You have to follow the guidelines. You have to be over age 40. You're only covered for a mammogram every 1 to 2 years -- the specifics depend on your policy, as outlined in its summary of benefits.
NOTE: Mammograms are only free as a screening for women without symptoms. If you go to the doctor with a symptom -- like a lump -- the mammogram is considered a "diagnostic test." In that case, you'll need to pay any deductibles and a copay or coinsurance, just as you would for other tests your doctor might use to rule out problems.
Are 3-D mammograms free too?
No. If you choose to have a 3-D mammogram or your doctor recommends one, your health plan can charge you an additional fee. 3-D mammograms are sometimes recommended for women with dense breast tissue and some plans may cover them if they are necessary.
Are follow-up tests and biopsies free, too?
No. Again, if you have symptoms, follow-up mammograms and biopsies are not screening tests. They are diagnostic tests and not part of the free screening.
If the mammogram shows I have cancer, is my treatment free?
No. If your screening shows that you do have cancer, you will be required to cover the cost of copays or coinsurance and deductibles for treatment as your plan guidelines dictate.
If you are enrolled in Medicaid, though, all states extend benefits to women whose breast cancer is found under the National Breast and Cervical Cancer Early Detection Program.
At High Risk? Check on BRCA Counseling
If people in your family have had breast cancer, you may get free genetic counseling. Doctors will ask questions about your family's medical history.
Based on your answers, they might do a test at no cost to see if you have certain genes. That test looks for what's called a mutation in your BRCA1 or BRCA2 genes. These genetic changes make you more likely to get breast and ovarian cancer.
Free Chemoprevention Counseling
You may be able to take medicines to lower your risk for breast cancer. These drugs block the effects of the hormone estrogen, which can cause breast cancer to grow. This approach is called chemoprevention.
If you're at high risk for breast cancer, you can get free counseling to discuss whether you might need chemoprevention.
NOTE: Only the counseling is free. If you need the treatment, you'll have to pay for the medicines and associated doctor appointments. What you pay depends on your health plan's deductible and copay or coinsurance amounts.
Counseling to Help Lower Risks for Breast Cancer
Rules for Health Plans
Private health plans. Health plans must offer breast cancer screening coverage without requiring you to pay a copay or a deductible at the time of your visit.
Health plans in place before March 23, 2010, that have not substantially changed are grandfathered. This means that they're exempt from this requirement of the law. They can still require you to pay a copay or deductible for breast cancer prevention care.
If you're not sure if your health plan is grandfathered, you can call your insurance company, your state insurance department, or ask your HR department if you enroll in health insurance through work.
Short-term health plans, those that insure you for less than 12 months, also do not have to provide free breast cancer screening.
Medicare. Medicare pays the full cost of breast cancer screening tests and prevention.
Medicaid. If you gain access to Medicaid coverage as part of the program’s expansion under the Affordable Care Act, you get breast cancer prevention services with no copay or deductible.
But if you already are part of Medicaid, you may have a small copay. The rules vary by state. Check with your local Medicaid office.
Early Detection Program (NBCCEDP). The Centers for Disease Control and Prevention (CDC) offers free breast cancer screening tests for women who have low incomes or no health insurance. This is part of the National Breast and Cervical Cancer Early Detection Program (NBCCEDP).
Whether you can take part in this depends on your age and income. If you qualify and are diagnosed with breast cancer, you can get Medicaid coverage for your cancer treatment.
How can I find out if I'm eligible for the National Breast and Cervical Cancer Early Detection Program?
In general, you're eligible if you have no health insurance, are over age 40 (age 21 for cervical cancer screening) and your income is less than 250% of the federal poverty level.
In plain words, that means you're eligible in 2020 if you are the only one in your household and you make less than about $31,900. If you have a family of four, you may qualify if your family income is less than about $65,500 a year.
Check with your state health department for more information. You also can call the CDC at 800-CDC-INFO (800-232-4636) or visit its web site to find the link to your state program.