Narrowing the Pink Tax in Healthcare
Women often face higher healthcare costs than men, even when using a similar volume of healthcare services. The difference has been estimated at approximately 20%, contributing to what is increasingly described as the healthcare “pink tax.”
One area where that disparity can become especially apparent is breast imaging. A woman may receive a screening mammogram at no cost, only to face a deductible, copay or coinsurance when an abnormal result requires additional imaging.
Recent changes to preventive coverage requirements under the Affordable Care Act (ACA) could help change that.
What Has Changed?
The definition of breast cancer screening under ACA preventive care requirements has expanded. For non-grandfathered health plans, certain breast imaging needed to complete the screening process following an abnormal mammogram is now covered without member cost sharing.
That distinction matters.
An abnormal screening mammogram frequently requires additional imaging to determine whether further evaluation or care is needed. In the past, that next step could be considered diagnostic rather than preventive, leaving the patient responsible for some or all of the cost.
For a woman already concerned about an abnormal result, uncertainty about the cost of additional imaging can add another layer of stress and potentially become a barrier to timely follow-up.
Expanding preventive coverage to qualifying follow-up breast imaging can help remove that barrier.
Could This Help Narrow the Pink Tax?
There is an estimated 20% difference between what women and men pay within health plans for a similar volume of care. The expanded breast imaging coverage could potentially reduce that difference by as much as 10 percentage points.
While this change does not eliminate the broader disparity in healthcare costs, it represents a meaningful step toward reducing an expense that disproportionately affects women.
It also highlights something employers and benefits advisors know well: a benefit only delivers its full value when it is implemented correctly and members understand how to use it.
What Employers and Brokers Should Do Now
Implementation may vary by plan. Green Imaging does not always know whether an employer's plan is grandfathered or non-grandfathered, or whether the carrier or TPA has updated the plan configuration to reflect the current requirements.
Employers and brokers should connect with their carrier or TPA and ask:
- Is the health plan grandfathered or non-grandfathered?
- Has the plan been updated to reflect the current preventive coverage requirements for follow-up breast imaging?
- How will qualifying imaging following an abnormal screening mammogram be processed?
- Are members being informed about the change?
For current Green Imaging clients, we also ask that you notify our team once this benefit has been implemented.
Having accurate information about your plan's benefit structure helps Green Imaging appropriately guide members who need follow-up breast imaging and helps members better understand what to expect before receiving care.
Turning a Coverage Change Into a Better Member Experience
With Breast Cancer Awareness Month approaching, there will be increased attention on the importance of mammograms and early detection. It is also an ideal time to make sure women understand what happens after a screening mammogram, particularly when additional imaging is recommended.
For employers and brokers, reviewing this benefit now can help reduce financial barriers, improve communication and make an important benefit easier for members to navigate.
It is also one practical step toward narrowing the pink tax in healthcare.
