Mammogram coverage set in Maine law

Posted Nov. 24, 2009, at 8:40 p.m.

AUGUSTA, Maine — Recent advisories recommending a decrease in the use of mammograms and Pap smears for detecting cancer in women will not affect insurance coverage for the screenings in Maine.

“We want to assure Maine women that there are important consumer protections in place for cancer screenings related specifically to women’s health,” state Insurance Superintendent Mila Kofman said Monday. “Maine law is not contingent upon advisories from commissions or other groups.”

The U.S. Protective Services Task Force recently changed its recommendations regarding the age at which women should start getting mammograms and the frequency of screening thereafter. The new recommendations suggest routine mammograms should begin at age 50 rather than the previous recommendation of age 40. Other medical organizations say the age 40 recommendation should remain unchanged.

Within days of the publication of the task force recommendations, the American College of Obstetricians and Gynecologists released new guidelines for Pap tests, recommending that women be screened less often and start being screened later in life.

State law requires that health maintenance organizations, individual policies and all group policies that cover radiologic procedures reimburse for mammograms at least once a year for women age 40 or older. HMOs and group policies also must cover Pap tests for cervical cancer, but nongroup policies are not required to cover the Pap test.

Employers with self-insured plans are not subject to state insurance laws.

Kofman said the decision to screen for breast and cervical cancers should be made between women and their doctors.

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