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Common questions about colorectal cancer screenings and insurance coverage.
The federal Affordable Care Act (ACA) legislation, which will continue to phase in over the next two years, will change the way health insurance works in America for many people. Even though some will not recognize any significant changes in their coverage or options, most have questions about what the ACA means to them, today and tomorrow. As part of the ACA, nearly everyone is ensured no-cost coverage for many screening exams, including those for colorectal, breast, and cervical cancers.
I'm between the ages of 50-75 and I'm looking to get my recommended colorectal screening, am I covered?
The ACA ensures that everyone between the ages of 50-75 is guaranteed no-cost screening for colorectal cancer, with a few exceptions. All grandfathered plans – or plans that have not changed since March 23, 2010 - are exempt from provisions in the ACA. However, grandfathered plans in states with laws requiring coverage for colorectal cancer screening are still required to cover screenings based on those laws. Some grandfathered plans in states without laws requiring coverage for colorectal cancer screenings still choose to cover colorectal cancer screenings voluntarily. See below to find out if you live in an “A” state. And if not, check with your insurance company for more details about your coverage.
I am under the age of 50, but colon cancer runs in my family. Will my insurance pay for a colonoscopy?
That depends. There are still 20 states that do not have legislation in place to require insurance companies to cover the costs for colon cancer screenings for those younger than 50 but who have other risk factors. While the ACA will mandate insurance coverage for men and women between the ages of 50 and 75, if you are younger than 50 and live in one of the states listed below, your insurance company may require a significant co-pay for colorectal cancer screening tests, or provide no coverage at all -- even with a family history.
States with legislation recommending, but not requiring, insurance coverage for colorectal cancer screening tests:
States with no laws requiring coverage for colon cancer screenings:
|Montana||New Hampshire||New York||North Dakota|
|Ohio||South Carolina||South Dakota||Utah|
I’ve heard a lot about new colon cancer screening tests like MRI and virtual colonoscopy. Are those procedures covered by the ACA?
The ACA guidelines for coverage are developed by an independent task force of medical experts known as the United States Preventative Services Task Force (USPSTF). Their job is to recommend the basic services and preventative measures that should be required for coverage under the law at no additional out-of-pocket cost to patients. The USPSTF guidelines for colorectal cancer screenings currently encompass fecal occult blood tests, sigmoidoscopy or colonoscopy in adults beginning at age 50 and continuing to age 75. There is no provision under the USPSTF for other procedures like virtual colonoscopy. However, states with “A” legislation, as ranked by the National Colorectal Cancer Legislation Report Card, have provisions for insurance coverage of new and emerging procedures. They include:
|New Mexico||North Carolina||Oregon||Rhode Island|
What happens when I turn 75? Am I no longer covered for colorectal cancer screenings?
While the USPSTF guidelines for colon cancer screenings only cover those from age 50 until 75, those aged 65 and above are covered by Medicare guidelines, which also mandate regular colorectal cancer screenings for all.