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Under the Affordable Care Act, what are rules for health plans when it comes to breast cancer screening coverage?

ANSWER

Under the Affordable Care Act:

Rules vary by state.

  • Private health plans must offer breast cancer screening coverage without a copay a deductible.
  • Short-term health plans (those that last less than 12 months) don’t have to provide free breast cancer screenings.
  • Medicare pays the full cost of breast cancer screening tests and prevention.
  • Medicaid may offer breast cancer prevention services with no copay or deductible.

From: Free Breast Cancer Screening & Prevention WebMD Medical Reference

SOURCES:

U.S. Department of Health and Human Services:  "Preventive health services for adults;" "Preventive health services for women;" "Talk with a Doctor If Breast or Ovarian Cancer Runs in Your Family;" "Get Tested for Breast Cancer;" and "2013 Poverty Guidelines."

U.S. Preventive Services Task Force: "USPSTF A and B Recommendations."

American Cancer Society: "Affordable Care Act: Breast Cancer Screening;" "Cancer Prevention, Screening & Treatment Under the Affordable Care Act;" "Paying For Breast Cancer Screening;" "Medicare Coverage for Cancer Prevention and Early Detection."

Community Catalyst and the Center for Health Insurance Studies, Georgetown University Health Policy Institute: "Essential Benefit Package."

CMS.gov: "Affordable Care Act Implementation FAQs - Set 12."

FamiliesUSA.org: "2016 Federal Poverty Guidelines."

Surveillance, Epidemiology and End Results Program, “SEER Stat Fact Sheets: Breast Cancer.”  


Reviewed by Sarah Goodell on September 17, 2018

SOURCES:

U.S. Department of Health and Human Services:  "Preventive health services for adults;" "Preventive health services for women;" "Talk with a Doctor If Breast or Ovarian Cancer Runs in Your Family;" "Get Tested for Breast Cancer;" and "2013 Poverty Guidelines."

U.S. Preventive Services Task Force: "USPSTF A and B Recommendations."

American Cancer Society: "Affordable Care Act: Breast Cancer Screening;" "Cancer Prevention, Screening & Treatment Under the Affordable Care Act;" "Paying For Breast Cancer Screening;" "Medicare Coverage for Cancer Prevention and Early Detection."

Community Catalyst and the Center for Health Insurance Studies, Georgetown University Health Policy Institute: "Essential Benefit Package."

CMS.gov: "Affordable Care Act Implementation FAQs - Set 12."

FamiliesUSA.org: "2016 Federal Poverty Guidelines."

Surveillance, Epidemiology and End Results Program, “SEER Stat Fact Sheets: Breast Cancer.”  


Reviewed by Sarah Goodell on September 17, 2018

NEXT QUESTION:

Can women who have low incomes or no health insurance get free breast cancer screening tests?

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