Screening mammograms are covered at no cost ; Both Medicare and the Affordable Care Act provide the safeguard

Times-Union readers want to know:

I've received this email for the third time that says that yearly mammograms for women over 70 will not be covered by Medicare or Obamacare. Is that true?

We're getting many emails about the Affordable Care Act. It's a lot to take in, so we'll try to clear up what we can.

Regular Medicare plans began covering screening mammograms every 12 months for no cost in 2011, and all Medicare Advantage plans - typically the ones with extra benefits and low or no premiums offered by private insurers - were required to do so as of 2012, according to the Medicare Rights Center, a nonprofit group that offers counseling and assistance to Medicare beneficiaries.

The ACA requires insurers to cover a mammography screening at no cost every one to two years starting at age 40. Since the ACA insurance coverage doesn't begin until Jan. 1 at the earliest, there are no reports on coverage or lack of coverage for seniors.

(A no-cost baseline mammogram is available for women ages 35-39. For a diagnostic mammogram, usually performed when an abnormality is found on the screening mammogram, Medicare patients pay 20 percent of the Medicare-approved amount, and the Part B deductible applies. Patients using insurance under the ACA might also receive a bill depending on their plan's deductible.)

Before the ACA, seniors not eligible for Medicare had to pay 20 percent of the cost of a screening mammogram. Coverage varied in private plans, but under the ACA, the free mammograms are required preventive coverage (this is for non-grandfathered plans starting on or after Sept. 23, 2010, FactCheck.org reports).

Mona Shah, associate director of federal relations for the American Cancer Society Cancer Action Network, told FactCheck.org that there wasn't any upper age limit with Medicare - a fact that a Centers for Medicare and Medicaid Services spokeswoman also confirmed - and her organization hadn't heard anything about women being denied coverage.

Mitchell Clark, the senior communications associate at the Medicare Rights Center, also told FactCheck.org that his group hadn't "heard of any issues where people have been denied coverage of mammogram or had trouble getting a mammogram based on their age, but we do get calls from time to time about unexpected costs."

The group notes that while the preventive services are free, there might be a facility fee at certain hospitals or an office visit fee if the patient has a doctor's appointment before or after the preventive screening.

FactCheck.org, the nonpartisan fact-finding project of the Annenberg Public Policy Center at the University of Pennsylvania, also called the American Geriatrics Society. Carol Goodwin, associate vice president of communications, said: "We have not been getting any specific reports from our members or the public that screenings have been denied for women over the age of 74."

The American Cancer Society recommends women continue yearly mammograms "as long as they are in good health."

For elderly women, mammograms should continue "as long as she does not have serious, chronic health problems such as congestive heart failure, end-stage renal disease, chronic obstructive pulmonary disease, and moderate to severe dementia," the ACS says.

The "74" age claim mentioned in the viral email probably came after the U.S. Preventive Services Task Force's controversial mammography recommendations in 2009, FactCheck.org states.

Those recommendations advised screening every two years starting at age 50. It said that for women younger than 50, the decision to have a mammogram should be an "individual one and take patient context into account, including the patient's values regarding specific benefits and harms." The harms were mainly false positive tests.

As for women 75 and older, the task force said evidence wasn't available to determine benefits versus harms for that age group.

The American Cancer Society, the Susan G. Komen for the Cure organization, the American College of Obstetrics and Gynecology and the American College of Radiology denounced those recommendations.

Now, the 2009 recommendations did not say that women under 50 or over 74 shouldn't get mammograms at all, even though political ads and interviews on conservative websites promulgated that view.

At the time the recommendations came out, Congress was debating health care overhaul legislation. On Dec. 3, 2009, the Senate passed an amendment that required full coverage of annual mammograms, including for women under 50, and many other preventive services. On the same day, the Senate agreed without a vote to an amendment that said the law should ignore the task force's 2009 recommendations.

And that is what the final health care act states:

"[F]or the purposes of this Act, and for the purposes of any other provision of law, the [2009] current recommendations of the United States Preventive Service Task Force regarding breast cancer screening, mammography, and prevention shall be considered the most current other than those issued in or around November 2009." (The emphasis is ours.)

That means that the previous 2002 guidelines - recommending screening mammography every one to two years for women ages 40 and older - provide the minimum coverage requirements in the Affordable Care Act.

But the misinformation continues, as FactCheck.org points out.

Kris Held, anophthalmologist and ophthalmic surgeon in Texas, a breast cancer survivor and a founder of American Doctors 4 Truth, a group that opposes the ACA, was interviewed by Elizabeth Hasselbeck on Fox News on Sept. 25. Held said that "Obamacare has panels and task forces which have changed the very recommendations" for mammography.

A graphic on the screen listed "Mammogram Restrictions," including "Screenings starting at age 50, not 40" and "Screenings end at age 74."

FactCheck.org talked to Held, who maintained that mammograms weren't covered by Medicare for women over age 74, saying her 78- year-old mother "went to have one, and they didn't cover it this year."

FactCheck.org challenged that, and Held said in a subsequent email that her mother "got through to Medicare" on Oct. 16, and was told annual mammograms are covered."In fact, if a doctor says it's medically necessary, a woman could even have one more often" than annually, Held wrote to FactCheck.org. "I hope it stays that way."

The bottom line: Screening mammograms are covered at no cost under Medicare and the Affordable Care Act.Carole Fader: (904) 359- 4635FACT CHECKWant something checked out? If you see or hear about something that needs a Fact Check, e-mail [email protected]