Cancer screening tests are a type of preventive medical service. They are included as part of the essential health benefits that must be covered by any health plan you enroll in from your state's health insurance Marketplace. In fact, plans must offer certain free cancer screening tests if they want to be part of the Marketplace.
Free Cancer Screening Tests
Experts have learned that screening tests for certain types of cancer can save lives. Here's what you need to know about screenings for some common cancers.
Breast cancer . Breast cancer is the most commonly diagnosed cancer in women. It is also the second leading cause of cancer deaths among women. Mammograms can help find breast cancer early. This screening is just one part of preventive care women can get without having to pay a copay or coinsurance.
Check with your insurance company to find out your coverage. Some plans only cover mammograms every two years, and others pay for them every year. Under some plans, you have to be 40 or older to receive a free mammogram. The American Cancer Society recommends that you wait until age 45 to have a mammogram. If you are high-risk, you might be able to receive a mammogram earlier
Insurance plans that existed before March 2010 might not offer free mammograms. Always check your coverage before scheduling a screening test.
The Affordable Care Act requires that most private health plans provide Pap tests and cervical cancer screening without asking women to pay a copay or coinsurance. Women older than 30 may have HPV testing every 3 years, regardless of Pap smear results.
Private health plans that were in place before the law was passed in March 2010 are the exceptions. These "grandfathered plans" don't have to offer free tests. Some of them may do it anyway, though. Check your plan's summary of benefits, or call your insurer if you aren't sure if your plan is grandfathered.
Colon cancer. Nine out of 10 people survive long-term if their colon cancer is caught early. However, just 40% of colorectal cancers are found at that early stage. If the cancer spreads to nearby organs or lymph nodes, the 5-year survival rate goes down to 70%. If it spreads to distant organs, your survival rate drops to 12%.
Under the Affordable Care Act, private health plans must offer one of several different types of screening tests for colon cancer. After age 50, you can receive a fecal blood test, a sigmoidoscopy, or a colonoscopy without owing a copay or coinsurance. Again, this does not apply to grandfathered plans so be sure to check your plan's summary of benefits.
Medicare coverage also offers free colon cancer screening tests. It's possible, though, that you might have to pay copay for the doctor’s visit, anesthesia, or hospital visit.
What Medicaid will cover depends on which state you live in.
If you are a longtime smoker, you may be able to get free testing under new lung cancer screening guidelines. In early 2015, the federal government adopted these guidelines and is providing coverage.
The test is a once-a-year, low-dose CT scan. You could get this screening if all of these are true for you:
- You're 55 to 80 years old.
- You have smoked one pack a day for 30 years. Or you have smoked two packs a day for 15 years.
- You now smoke, or have quit in the past 15 years.
Lung cancer screening is seen as a preventive measure, just like cervical and colon cancer screening tests. Medicare and Medicaid also offer free screenings. You are also able to get it with a private plan that took effect after the Affordable Care Act was signed into law on March 23, 2010.
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.