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Health Care Reform:

Health Insurance & Affordable Care Act

Cancer Screening and Prevention Under Health Reform

Rules on Free Screening Tests

Here's what you should know about cancer screening tests:

Does everyone get a free screening? The Affordable Care Act requires cancer screening tests only from health plans that started on or after March 23, 2010. If your plan was in place before then, you should call your insurance company to see if you get free screening tests. Otherwise, you might need to meet your plan’s deductible or pay a copay or coinsurance at the time of your appointment.

Your state might require that private health plans and Medicaid offer free screenings. Call your state health department or Medicaid office to see what is covered. Medicare does cover cancer screenings free of charge.

Keep in mind, though, that screening tests without any extra costs are just for people who don’t have any symptoms. If you have symptoms and your doctor orders a colonoscopy, it is not considered a preventive screening test and is likely to come at a charge . If you have colon cancer and get a colonoscopy, it is not free either. In both of these cases, a colonoscopy is a diagnostic test, not a screening test.

Can I make an appointment just for the free screening? You can schedule a cancer screening by itself or as part of your annual checkup. For some screenings, you might need a separate visit to the doctor. A colonoscopy is one example. You can have others, like a Pap test, during a regular checkup.

Can anyone get a screening at any time? You must follow your health plan’s guidelines to get preventive screening tests. For example, you have to be 50 or older to get a colon cancer screening without having to pay for it. If you have a high risk of colon cancer, you can get checked every 2 years no matter how old you are without paying any costs. If you have an average risk, you can get a free colonoscopy only once every 10 years without paying.

Are follow-up tests and biopsies free, too? No. Follow-up tests and biopsies are diagnostic tests, not screenings. You may have to meet your plan’s deductible or pay a copay or coinsurance to your doctor and hospital if you need more testing.

If the screening shows I have cancer, is my treatment free? Most people will have copays, coinsurance, and deductibles for any cancer treatment. In some states, Medicaid covers some women with cervical cancer. This applies to women whose cancer was found through the National Breast and Cervical Cancer Early Detection Program.

WebMD Medical Reference

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