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Old 09 November 2014, 05:46 PM
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Icon13 No more mammograms for women under 40 or over 75

Comment: She told me that hospitals have already received their 2015
guidelines under our wonderful new "Affordable Health Care Act". Beginning
January 1, 2015, your insurance will not pay for a mammogram for women
under 40. Never mind that women in their 20's & 30's are diagnosed with
breast cancer everyday. From ages 50 to 75, your insurance will not pay
for a mammogram but every other year. For women like me who should have a
diagnostic mammo every year because of precancerous cells removed
previously, you will pay out of your own pocket or just run the risk by
not having one done. By the way, a diagnostic mammo & the doctors fees to
read it run about $2000. Add that to the health care premiums you already
pay!

Here's the kicker. after age 75, your insurance will not pay for a
mammogram at all. Guess the democrats think at 75 we're ready to die, so
let's don't prevent breast cancer at all. If you are diagnosed with breast
cancer after 75 at your own expense, your insurance is not required to pay
for treatment either.
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  #2  
Old 09 November 2014, 06:00 PM
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A Turtle Named Mack A Turtle Named Mack is offline
 
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There are new recommendations out that would call for much less of routine mammograms for non-high-rick women:
The U.S. Preventive Services Task Force (USPSTF) is recommending sweeping changes in its breast cancer screening guidelines.

The USPSTF, which is a group of independent health experts convened by the Department of Health and Human Services, reviewed and commissioned research to develop computer-simulated models comparing the expected outcomes under different screening scenarios.

Here are the USPSTF's recommendations, based on all that work:

Routine screening of average-risk women should begin at age 50, instead of age 40.
Routine screening should end at age 74.
Women should get screening mammograms every two years instead of every year.
Breast self-exams have little value, based on findings from several large studies.

http://www.webmd.com/breast-cancer/f...guidelines-faq

This article says that most insurers, including Medicare, are strongly influenced by the UPSTF positions, but at the time of this article, no decisions had been made yet.
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Old 09 November 2014, 06:23 PM
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Changes in recommendations for routine screening would not affect whether insurance will pay for screenings on a different schedule when they are medically indicated. So a woman who has a medical reason, like significantly increased risk of breast cancer, or precancerous cells, would almost certainly be covered.

Also, dropping screenings at 75 doesn't mean no one over that age will get a mammogram. It probably means that screenings don't really increase survival at that age. Women who notice a lump will still get a mammogram and treatment. But mammograms may cause more harm than good when used for screening at that age.
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Old 09 November 2014, 08:47 PM
Singing in the Drizzle Singing in the Drizzle is offline
 
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Since ACA does not pay anything until you used up your deductible, you are most likely going to pay for cost out of pocket even if it is covered.
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Old 09 November 2014, 08:58 PM
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The ACA doesn't pay for anything, period. It sets minimum coverage for a policy to be qualifying health insurance. You can get a policy with a lower deductible, or no deductible if you choose and can afford it.
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Old 09 November 2014, 10:21 PM
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And even the most basic policies pay for some preventative exams whether or not you've used up the deductible, I believe (which wasn't always true before the ACA).
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Old 09 November 2014, 11:03 PM
jimmy101_again jimmy101_again is offline
 
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Quote:
Originally Posted by Singing in the Drizzle View Post
Since ACA does not pay anything until you used up your deductible, you are most likely going to pay for cost out of pocket even if it is covered.
What Erwins said about ACA not paying for things since it isn't what ACA is. Some insurances pay for preventative care even before the deductible is used up. For example, my insurance covers flu shots even if the deducatable hasn't yet been met. I suspect a fair number of insurance policies cover mammogram. If the standard for who should get a mammogram changes then that coverage is likely to change (and it should).
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Old 09 November 2014, 11:14 PM
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Sylvanz Sylvanz is offline
 
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AFAIK, the ACA, the law, requires insurance companies cover many preventative services 100% in spite of deductible. That is if they offer coverage through the market place or are employer qualified policies.
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Old 09 November 2014, 11:40 PM
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Here's what the ACA requires companies to cover:

https://www.healthcare.gov/preventive-care-benefits/

Quote:
Free preventive services

All Marketplace plans and many other plans must cover the following list of preventive services without charging you a copayment or coinsurance. This is true even if you havenít met your yearly deductible.

This applies only when these services are delivered by a network provider.

Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked
Alcohol Misuse screening and counseling
Aspirin use to prevent cardiovascular disease for men and women of certain ages
Blood Pressure screening for all adults
Cholesterol screening for adults of certain ages or at higher risk
Colorectal Cancer screening for adults over 50
Depression screening for adults
Diabetes (Type 2) screening for adults with high blood pressure
Diet counseling for adults at higher risk for chronic disease
HIV screening for everyone ages 15 to 65, and other ages at increased risk

Immunization vaccines for adults--doses, recommended ages, and recommended populations vary:
Hepatitis A
Hepatitis B
Herpes Zoster
Human Papillomavirus
Influenza (Flu Shot)
Measles, Mumps, Rubella
Meningococcal
Pneumococcal
Tetanus, Diphtheria, Pertussis
Varicella

Obesity screening and counseling for all adults
Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk
Syphilis screening for all adults at higher risk
Tobacco Use screening for all adults and cessation interventions for tobacco users
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