As we’ve shared, there are several different ways to screen for colorectal cancer. Most of these tests are free for adults aged 50-75 with insurance, thanks to the Affordable Care Act requirement that screening tests be covered without patient cost-sharing if they receive an “A” or “B” rating from the United States Preventative Services Task Force (USPSTF).
An added benefit of some screening tests – such as colonoscopies – is that in addition to finding cancer, they also help doctors identify and remove polyps before they can turn into cancer, making these tests a very effective form of cancer prevention.
For people with private insurance these tests should be free, regardless of whether a polyp is removed during the procedure. (This is thanks to a clarification issued by the Centers for Medicare and Medicaid Services in 2013.) However, for people covered by Medicare, the exact same procedure can end up being quite expensive. This is because of a loophole that classifies a screening test that also involves a polyp removal as diagnostic instead of preventative for Medicare patients.
A bipartisan bill currently before Congress, the Removing Barriers to Colorectal Cancer Screening Act of 2017, would close this loophole and clarify that Medicare patients who undergo a screening test that involves a polyp removal cannot be charged cost-sharing.
There are other situations in which patients may face unexpected cost-sharing during the screening process for colorectal cancer, depending on their insurance provider -- for example, when undergoing a colonoscopy after a positive result from another type of screening test (even though the USPSTF acknowledges a follow-up colonoscopy is required in this situation). Additional policy changes or guidance would be required to resolve these issues.
Evidence shows that when preventative services cost money, individuals are more likely to avoid them or postpone them. This is why the WI Comprehensive Cancer Control Plan 2015-2020 recommends promoting full insurance coverage for recommended cancer screenings, including diagnostic screenings. Since currently 1 out of 4 Wisconsin adults in the recommended age range are not getting screened, removing these barriers to screening is essential to reducing the burden of colorectal cancer in Wisconsin.