High Deductibles Create Barriers to Screening Mammograms, Follow-Up Tests

December 09, 2022 - High deductibles may discourage women from receiving follow-up testing after an abnormal mammogram, with one in five saying they would skip additional imaging if they knew they had to pay a deductible, according to a study presented at the Radiological Society of North America’s (RSNA) annual meeting.

High deductible health plans have become more common among Americans, especially younger healthy individuals. Higher deductibles help lower monthly premiums, presenting an affordable option for people who only utilize preventive or emergency care services.

However, high out-of-pocket deductibles may deter people from seeking needed care.

“The [Affordable Care Act] removed out-of-pocket costs for screening mammograms under most health plans to encourage women to partake in this important preventative health care measure,” Michael Ngo, MD, radiology resident at Boston Medical Center and Boston University Chobanian and Avedisian School of Medicine and the study’s lead author, said in the press release.

“However, the screening mammogram is only the first step in detecting breast cancer. If the radiologist detects an abnormal finding on the screening image, then additional images and a biopsy are needed to determine if the patient has cancer. The ACA does not mandate insurance to cover the costs of these additional services.”

Ngo and colleagues surveyed 932 patients that visited Boston Medical Center between September 2021 and February 2022 for breast imaging. The surveys had variable question response rates.

Among 714 respondents, 151 (21.2 percent) indicated they would skip additional imaging if they knew they would have to pay a deductible. Meanwhile, 424 respondents (59.4 percent) said they would not forgo imaging, and 139 people (19.5 percent) were undecided.

Hispanic individuals (33 percent), those with high school education or less (31 percent), people with household incomes under $35,000 (27 percent), and those with Medicaid or uninsured (31.5 percent) were the most likely to say they would skip follow-up imaging.

The survey also included a question about whether respondents would avoid receiving initial screening mammography exams if they knew they would have to pay a deductible for follow-up imaging. Among 707 respondents, 129, or 18.3 percent, reported they would skip a screening mammogram in this case.

Nearly a third (465 respondents) said they would not skip the exam, and 16 percent (113 respondents) were undecided.

“Our study demonstrates that out-of-pocket payments will discourage people, especially those belonging in the most vulnerable populations, from completing the last steps in the breast cancer screening process,” Ngo added. “These results could be used to advocate for legislation that will cover these important follow-up tests and prevent further exacerbation of existing health inequities.”

Low socioeconomic status has been linked to poor healthcare delivery, including high rates of avoidable hospital admissions and emergency department visits but lower instances of physician and care management visits.

Socioeconomic barriers can worsen care disparities by limiting access to comprehensive health insurance coverage and adversely impacting health outcomes, patient satisfaction, and physician perception of patient needs.

Although high deductible health plans may benefit certain populations, they have also been associated with financial challenges. For example, one study found that 12 percent of adults with high deductible health plans reported having medical debt, compared to 9.4 percent of Medicare beneficiaries.

Similarly, Urban Institute data from December 2021 revealed that higher deductibles were associated with a higher rate of medical bill struggles. Nearly 20 percent of adults with plans that had a deductible of $3,000 or more reported experiencing problems with paying medical bills, compared to 12.3 percent of people with no health plan deductible.