When the Affordable Care Act (ACA) passed, it required insurers to offer certain essential preventive services at no cost. But the March 2023 Braidwood v. Becerra decision struck down that portion of the law and, if the ruling holds, will return cost sharing for many recommended services. A provision of the Consolidated Appropriations Act of 2023 protects mammography and other breast cancer preventive services from the implications of Braidwood through January 1, 2025, but no later. In this fact sheet, we examine mammogram utilization among women ages 50 to 64 enrolled in private health plans.

Why this matters

Mammograms are essential to early detection and treatment of breast cancer but can be a costly service if not covered by insurance.

What we found

• 2 million women ages 50 to 64 were enrolled in a private health plan in 2018 and, therefore, likely eligible for a free mammogram under the ACA.
• 3 percent of women ages 50 to 64 who were enrolled in a private health plan reported having a mammogram within the previous two years.
• Cost-sharing could reduce adherence to mammogram screening recommendations: 11.0 percent of women ages 50 to 64 who were enrolled in a private health plan report having delayed or not received medical care in the previous year because of costs.
• Low-income women and women with less than a high school diploma were less likely to have had a mammogram in the past two years and could be disproportionately affected by increases in cost sharing.

How we did it

We used the 2018 Medical Expenditure Panel Survey (MEPS) Household Component, a nationally representative survey of the civilian noninstitutionalized population, to measure mammogram utilization by key demographic characteristics.