Health Insurance
Nearly 4 in 5 Women Getting Recommended Routine Mammograms, Though Rates Rise in Some States, Fall in Others
October brings with it breast cancer awareness — a month to recognize the most type of cancer in the U.S., one that women are particularly at risk of developing. According to Breastcancer.org, about 1 in 8 American women will develop invasive breast cancer during their life, with 287,850 new cases estimated in the U.S. in 2022.
To increase awareness of Breast Cancer Awareness Month, ValuePenguin researchers analyzed the percentage of women in the U.S. receiving mammograms as recommended. Here’s what we found at the national and state level.
On this page
- Key findings
- Between 2018 and 2020, 78% of women received a mammogram as recommended
- Which states have the highest (and lowest) mammogram rates?
- Though the national shift was minimal, state mammogram rates fluctuate more widely between 2016 and 2020
- Average out-of-pocket mammogram costs top $200
- Methodology
Key findings
- 78.1% of American women ages 50 to 74 received a mammogram between 2018 and 2020. Women in this age range are recommended to receive one annually or biennially (every two years), depending on screening guidelines. This rate was stable nationally between 2016 and 2020.
- Two New England states had more than 85% of women ages 50 to 74 who received a mammogram between 2018 and 2020. Massachusetts (88.1%) topped the list, followed by Delaware (86.1%) and Rhode Island (85.6%).
- In the same time frame, five states had fewer than 70% of women in the recommended age range who received a mammogram. Arkansas had the lowest rate at 68.1%. Following that, other low-ranking states included Idaho (68.9%), Alaska (68.9%), Wyoming (69.4%) and Mississippi (69.6%).
- At the state level between 2016 and 2020, the rate of women who received mammograms fluctuated. Over the four years, mammogram rates increased in 23 states and the District of Columbia, but they fell in 27. Pandemic shutdowns didn’t seem to be a major driver nationally in that period, as 26 states saw their rates drop between 2016 and 2018.
- Because of the Affordable Care Act, biennial mammograms are fully covered for insured women 50 and older. Women ages 40 to 49 are covered when a doctor recommends one. However, for the 7% of women without health insurance, the average out-of-pocket cost for a preventive mammogram is $227, while a diagnostic mammogram costs $265. Additionally, the average biopsy costs $4,841.
Between 2018 and 2020, 78% of women received a mammogram as recommended
From 2018 to 2020, 78.1% of American women ages 50 to 74 received a mammogram. Because women in this age group are at an increased risk of developing breast cancer, medical recommendations say women should’ve received at least one mammogram in that period. According to various screening guidelines, women should receive a mammogram annually or biennially:
- The U.S. Preventive Services Task Force recommends mammograms every two years for women ages 50 to 74.
- The American Cancer Society recommends annual mammograms for women ages 45 to 54, then every two years at age 55 or older.
- The American College of Radiology recommends annual mammograms starting at age 40.
While it’s good that most women who fall within the recommended ages received a mammogram, ValuePenguin health insurance expert Robin Townsend says that figure should be higher than 78.1%.
"An ideal percentage would be 100%," Townsend says. "Every woman — even those at average risk — should get mammograms as recommended. It’s a simple, quick screening that helps detect cancer early so it can be treated before it spreads. Put simply, early detection of breast cancer leads to higher survival rates."
Despite the risks, the national mammogram rates haven’t changed much between 2016 (when the CDC started providing data on the 50 to 74 age range) and 2020 (the most recent data available). However, a state-by-state analysis paints a much different picture.
Which states have the highest (and lowest) mammogram rates?
While the national mammogram rate hovers just above 78%, the percentages vary widely by state. On the upper end of the list, two New England states had more than 85% of women ages 50 to 74 who received a mammogram between 2018 and 2020 — 7 percentage points higher than the national average. Those were:
- Massachusetts (88.1%)
- Delaware (86.1%)
- Rhode Island (85.6%)
Health insurance rates may have something to do with these state rankings. Rhode Island has the lowest uninsured rate in the U.S. at 2.4%, according to a recent ValuePenguin study. Delaware and Massachusetts aren’t far behind, with the fifth- and sixth-lowest uninsured rates, respectively.
On the other end of the list, five states had fewer than 70% of women in the recommended age range who received a mammogram. Those were:
- Arkansas (68.0%)
- Idaho (68.9%)
- Alaska (68.9%)
- Wyoming (69.4%)
- Mississippi (69.6%)
Similarly, women in these states may be less likely to receive a mammogram because they’re also among the least likely to have health insurance. Of these five states, four are among the 10 with the highest uninsured rates. Mississippi, in particular, has the highest uninsured rate in the U.S. at 14.4%. Alaska is the only exception here — with 7.8% of Alaska residents uninsured, it’s the 25th most uninsured state.
Full rankings: States with the highest mammogram rates
Rank | State | Percentage of women ages 50 to 74 who received a mammogram between 2018 and 2020 |
|---|---|---|
| United States | 78.1% | |
| 1 | Massachusetts | 88.1% |
| 2 | Delaware | 86.1% |
| 3 | Rhode Island | 85.6% |
| 4 | Connecticut | 83.9% |
| 5 | Hawaii | 83.7% |
| 6 | Maryland | 83.4% |
| 7 | New Hampshire | 83.3% |
| 8 | Maine | 83.0% |
| 9 | California | 82.9% |
| 10 | Michigan | 81.9% |
| 11 | Minnesota | 81.7% |
Source: ValuePenguin analysis of Behavioral Risk Factor Surveillance System data from the U.S. Centers for Disease Control and Prevention (CDC).
Though the national shift was minimal, state mammogram rates fluctuate more widely between 2016 and 2020
Nationally, mammogram rates didn’t change much between 2016 and 2020 — dipping by 0.3% — but some states had significant fluctuations.
Over those four years, mammogram rates increased in 23 states and the District of Columbia but fell in 27. Shutdowns from the COVID-19 pandemic don’t seem to be a major driver nationally between 2018 and 2020, as 26 states also saw drops in mammogram rates between 2016 and 2018. Rather, Townsend says, access to insurance again seems to be the major driver.
"For example, mammogram rates in Oklahoma and Mississippi declined by a wide margin compared to some other states," Townsend says. "These states also have some of the highest uninsured rates. Without insurance or another way to cover the cost, women are much less likely to seek preventive care."
That’s evident among the states where mammogram rates fell the most, too. Between 2016 and 2020, mammogram rates fell:
- 8.6% (to 68.1%) in Arkansas
- 6.1% (to 72.1%) in Nevada
- 5.5% (to 72.5%) in Missouri
Next up, the rate in Mississippi — the state with the lowest rate of women who received mammograms — fell by 5.3% to 69.6%.
Meanwhile, between 2016 and 2020, mammogram rates rose:
- 9.3% (to 86.1%) in Delaware
- 8.7% (to 82.9%) in California
- 6.1% (to 83.3%) in New Hampshire
Full rankings: States with the biggest 4-year changes in mammogram rates
Rank | State | 2016 | 2020 | Change (points) | Change (%) |
|---|---|---|---|---|---|
| 1 | Delaware | 78.8% | 86.1% | 7.3 | 9.3% |
| 2 | California | 76.3% | 82.9% | 6.7 | 8.7% |
| 3 | New Hampshire | 78.5% | 83.3% | 4.8 | 6.1% |
| 4 | Vermont | 74.7% | 78.9% | 4.2 | 5.6% |
| 5 | Wyoming | 65.8% | 69.4% | 3.6 | 5.5% |
| 6 | Kentucky | 75.8% | 79.6% | 3.8 | 5.0% |
| 7 | Kansas | 73.4% | 76.3% | 3.0 | 4.0% |
| 8 | Michigan | 79.3% | 81.9% | 2.6 | 3.3% |
| 9 | Minnesota | 79.3% | 81.7% | 2.4 | 3.1% |
| 9 | Washington | 75.2% | 77.5% | 2.3 | 3.1% |
| 11 | Connecticut | 81.5% | 83.9% | 2.4 | 3.0% |
| 12 | Maryland | 81.3% | 83.4% | 2.1 | 2.6% |
Source: ValuePenguin analysis of Behavioral Risk Factor Surveillance System data from the CDC.
Average out-of-pocket mammogram costs top $200
Through the Affordable Care Act (ACA), biennial mammograms are fully covered for insured women ages 50 and older. Women ages 40 and up are covered when a doctor recommends a mammogram. However, women who don’t have insurance will likely pay more than $200, on average, for a routine checkup. The average out-of-pocket costs are:
- $227 for a preventative mammogram, or a standard screening.
- $265 for a diagnostic mammogram, or a secondary screening to investigate abnormal results from a standard screening.
- $4,841 for a biopsy, or a procedure to test tissue samples for cancer cells after abnormal screenings.
These costs come as 7% of women don’t have insurance, meaning they’re likely left footing the bill of an annual mammogram should they choose to receive one.
However, Townsend says some women with insurance may not have the cost of their mammograms covered, either.
"If women are insured but not covered, it’s either due to age — as in, they’re under 50 and don’t have a medical need for a mammogram, per most insurer guidelines — or because they’re on a short-term medical plan that restricts or doesn’t cover mammograms," she says.
While the cost may lead some women to put off a mammogram until their insurance covers it, paying for regular mammograms can prevent heftier medical costs in the long run. Early cancer detection and treatment are critical in reducing one’s likelihood of developing metastatic (typically incurable) breast cancer. What’s more, ealth care spending for cancer treatment has risen from $138.2 billion in 2016 to $169.6 billion in 2019 — a jump of almost 23%.
Annual spending on cancer treatment
Year | Spending (billions) |
|---|---|
| 2016 | $138.2 |
| 2017 | $145.4 |
| 2018 | $155.9 |
| 2019 | $169.6 |
Source: ValuePenguin analysis of Health Care Cost Institute data, via Guroo.
Mammogram not covered? Here’s what health insurance experts recommend
Regardless of your risk of breast cancer, Townsend says it’s best to start getting regular screening mammograms as soon as your insurance allows — or, if you can, even sooner.
"A mammogram can be worthwhile for women under 50," Townsend says. "The good news is that a doctor’s order or prescription isn’t required — women can schedule a screening directly with a mammogram provider. But unless there’s a medical reason for the test, you’ll likely end up footing the bill. Before going on your own, it’s best to find out whether your insurance will cover the charge and what your cost will be."
To offset the cost of a mammogram, Townsend recommends the following:
- Look into programs designed to offset costs. "Several programs provide mammograms to uninsured or underinsured women, including Federally Qualified Health Centers, local health systems and free clinics," Townsend says. "There’s also a CDC program — the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) — that provides access to breast cancer screening services depending on income."
- Determine if you qualify for Medicare. For eligible women, Medicare coverage for mammograms starts at age 40 — regardless of whether your doctor recommends it. Preventive mammograms are fully covered, while diagnostic mammograms are 80% covered. Townsend recommends checking with Medicare to see if you qualify.
- If your insurance doesn’t cover your mammogram, see if you can file an appeal. If your insurance rejects your request for mammogram coverage, Townsend says you can fight back. "If you do have insurance, you or your doctor can file an appeal to the insurer for coverage," Townsend says. "If you have a short-term medical plan, however, you’re not likely to successfully appeal. But in either case, if you need the care and it’s not covered, you should still get checked if you can."
Methodology
ValuePenguin researchers analyzed data from the Behavioral Risk Factor Surveillance System from the U.S. Centers for Disease Control and Prevention (CDC) to determine the rate of women ages 50 to 74 who received a mammogram within the last two years for 2020, 2018 and 2016.
Cost data was retrieved from the Health Care Cost Institute, via Guroo. Incident and mortality rates are from the National Cancer Institute, via CDC State Cancer Profiles.