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Health Care Reform:

Health Insurance & Affordable Care Act

Free Breast Cancer Screening & Prevention

Free Chemoprevention Counseling

You may be able to take medicines to lower your risk for breast cancer. These drugs block the effects of the hormone estrogen, which can cause breast cancer to grow. This approach is called chemoprevention.

If you're at high risk for breast cancer, you can get free counseling to discuss whether you might need chemoprevention.

NOTE: Only the counseling is free. If you need the treatment, you'll have to pay for the medicines and associated doctor appointments. What you pay depends on your health plan's deductible and copay or coinsurance amounts.

Counseling to Help Lower Risks for Breast Cancer

You also can get free preventive counseling to help you manage other breast cancer risk factors. These include obesity, alcohol abuse, and poor diet. Counseling to help with these issues is another essential health benefit.

Rules for Health Plans

Private health plans. Health plans must offer breast cancer screening and prevention coverage without requiring you to pay a copay or a deductible at the time of your visit.

Health plans in place before March 23, 2010, are grandfathered. This means that they're exempt from this requirement of the law. They can still charge a copay or deductible for breast-cancer-prevention care.

If you're not sure if your health plan is grandfathered, you can call your insurance company, your state insurance department, or ask your HR department if you enroll in health insurance through work.

Medicare. Medicare pays the full cost of breast cancer screening tests and prevention.

Medicaid. If you gain access to Medicaid coverage starting in 2014 as part of the program’s expansion under the Affordable Care Act, you might get breast-cancer-prevention services with no copay or deductible.

But if you already are part of Medicaid, you may have a copay. The rules vary by state. Check with your local Medicaid office.

Early Detection Program (NBCCEDP). The Centers for Disease Control and Prevention (CDC) offers free breast cancer screening tests for women who have low incomes or no health insurance. This is part of the National Breast and Cervical Cancer Early Detection Program (NBCCEDP).  

Whether you can take part in this depends on your age and income. If you qualify and are diagnosed with breast cancer, you can get Medicaid coverage for your cancer treatment.

How can I find out if I'm eligible for the National Breast and Cervical Cancer Early Detection Program?

In general, you're eligible if you have no health insurance and your income is less than 250% of the federal poverty level. In plain words, that means you're eligible if you are getting insurance only for yourself and you make less than about $28,725 for the year 2013.

If you have health insurance for a family of four, you may qualify if your family income is less than about $58,875 a year.

Check with your state health department for more information. You also can call the CDC at 1-800-CDC-INFO (1-800-232-4636).

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