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3-D Mammograms Are Now Fully Covered by Your Insurance, If You Qualify

By Nicole Levy | March 1, 2017 4:21pm
 Three-dimensional mammography uses X-ray photos and computer software to compile a 3-D image of the breast.
Three-dimensional mammography uses X-ray photos and computer software to compile a 3-D image of the breast.
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NEW YORK CITY — Health insurers in New York state are now required to cover 3-D mammograms with no-cost sharing, Gov. Andrew Cuomo announced in a clarifying statement Tuesday

Earlier this week, New York State Health Bureau chief Lisette Johnson also wrote a letter to insurers clarifying that both 2-D and 3-D mammography qualify for full coverage if deemed medically necessary. New Yorkers won't be paying for 3-D mammograms in any form — as deductible, co-insurance, or co- payments.

So what exactly does all this jargon mean? "Your Good Health" breaks it down for you below:

► What is 3-D mammography?

Three-dimensional mammography uses X-ray machines take multiple pictures of the breast from different angles. Computer software then compiles them into one 3-D image. You might also hear it referred to as digital breast tomosynthesis.

► What's wrong with my 2-D mammogram?

Nothing — it's still the standard according to the U.S. Preventative Services Task Force, which recommends screenings every two years for women ages 54 to 70

But studies have shown that 3-D mammography may be more effective at detecting cancer in dense breast tissue than its 2-D counterpart. It's more difficult for doctors to interpret the mammogram of a woman with dense, rather than fatty, breast tissue because malignant cell growth and dense breast tissue both appear white in X-ray images.

► Who typically has dense breast tissue?

Dense breast tissue is more common in women of color, particularly black women.

According to the Susan G. Komen Foundation, screening mammography rates for black and white women age 40 and older are the same, but a significantly larger percentage of black patients are dying from the disease despite a lower rate of new cases of breast cancer among black women. In 2013, the breast cancer mortality rate for African American women was 39 percent higher than that for Caucasian women.

Dense breast tissue is one of many factors that may explain the survival rate gap. Others include access to care, income inequality and a high incidence of particularly aggressive breast cancer in black women.

► When is a mammogram "medically necessary?"

New York Insurance Law has a broader definition of this than the U.S. Preventative Services Task Force. Since 2016, the state has required that insurers cover the full cost of screenings for their customers in the following cases: when a doctor prescribes a mammogram for a woman who has a history of breast cancer or a first-degree relative with a history of breast cancer; when a woman seeks a single baseline mammogram between the ages of 35 and 39; and once a year for women ages 40 and older.  

Johnson's letter clarified the state's insurance rules to ensure women in those qualifying circumstances wouldn't be responsible for the costs.