Does Your Health Plan Cover the Cancer Screenings You Need?

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Does Your Health Plan Cover the Cancer Screenings You Need?

Screening is one of the most powerful tools we have in the fight against cancer. With screenings, we can detect cancer in early stages and greatly increase the likelihood of survival. However, a report issued recently by the Centers for Disease Control and Prevention (CDC) shows cancer screenings are still underutilized. In 2015, two in five adults reported not being up-to-date on their colorectal cancer screenings. This year alone, more than 600,000 people will lose their lives to cancer—but you don’t have to be one of them.

By talking to your healthcare professional about the screenings that are right for you, you can prevent cancer or detect it early, when treatment has a better chance of leading to a successful outcome. Like many Americans, you could be missing out on lifesaving screenings because your insurance policy doesn’t cover them or you simply don’t know which tests are covered.

You are not alone. A review that was recently published by the Prevent Cancer Foundation® shows how widely insurance coverage varies based on your plan. Our research found that guidelines issued by three leading organizations―the American Cancer Society (ACS), the National Comprehensive Cancer Network (NCCN), and the United States Preventive Services Task Force (USPSTF)―offer conflicting cancer screening recommendations, which creates confusion for patients, providers, and payers. The findings were published in “Cancer Screening: A Review of Guidelines and Insurance Coverage,” available in an e-book; a free download is available here.

Variations in coverage

The review summarizes current screening options for breast, cervical, colorectal, lung, and prostate cancer. It also provides an overview of the screening guidelines issued by all three organizations and compares screening coverage by the nation’s 30 largest health insurers. Some of the trends identified in the comparison of insurance coverage are as follows:

  • While all 30 plans cover 2D mammography, only 13 plans cover 3D mammography for breast cancer screening.
  • Virtually every plan covers low-dose CT screening for lung cancer; Pap tests alone or in combination with HPV tests for cervical cancer screening; and fecal occult blood tests (FOBT), stool-based DNA testing, colonoscopy, and flexible sigmoidoscopy for colorectal cancer screening.
  • All but two plans cover prostate-specific antigen (PSA) tests for prostate cancer screening, even though the USPSTF recommends against the screening.

You should be aware that your health plan may not cover every screening test available for all the types of cancers that can be detected early, even if those tests are recommended by your physician. When you and your loved ones lack access to cancer screening tests, your lives are at risk and we collectively fail to deliver on one of our best methods of prevention and early detection.

Variations in guidelines

A primary reason insurance plans have such vast differences in coverage is because the influential organizations on which they base their coverage have released inconsistent recommendations. Though USPSTF sets the federal standard for what insurance plans must cover, other plans choose to follow the recommendations of ACS or NCCN, both leaders in the cancer field. For cervical and colon cancer screening, guidelines between these organizations are fairly consistent. This is not true for breast and prostate cancer screening, where experts who have assessed the same evidence for risks and benefits have arrived at different conclusions. A good example of these differences is the wide variations in recommendations for breast cancer screening:

  • ACS states women age 40 to 44 should have the choice to begin annual mammograms, if they wish. They recommend women ages 45 to 54 receive annual mammograms and women 55 and older switch to mammograms every two years or continue yearly screenings, if preferred.
  • NCCN recommends women begin annual mammograms at age 40, with a note to consider tomosynthesis.
  • USPSTF recommends mammography screening every two years for women ages 50 to 74. (It’s important to know that the USPSTF recommendations are the basis of coverage by the Affordable Care Act.)

This variation among guidelines allows insurers to adopt cancer screening coverage policies that can keep patients from accessing lifesaving screenings.

Bernard Levin, MD, Co-chair of the Prevent Cancer Foundation® Scientific Review Panel and co-author of the e-book said,

“We know cancer screenings of all kinds can lead to early detection of these potentially deadly diseases—but the variations among guidelines allow insurance companies to adopt cancer screening coverage policies that significantly impact patients’ access to prevention”

A digital tool to help

At the Prevent Cancer Foundation®, we want to ensure you have the information you need to talk to your healthcare professional about available screenings. In order to help you understand your current insurance policy and when to talk to your healthcare professional about cancer screenings, the Foundation has released a digital tool to review insurance plans by states to find out what screenings are available and which ones your insurance covers. You may also compare your policy with other plans available in your state.

At the bottom of each screen, you’ll see the recommended age for screening from each organization. It is important to review this information with your healthcare professional, along with your family medical history, so you can discuss when to start getting screened, based on your family medical history and other personal risk factors.

The bottom line

Cancer screening is one of the country’s greatest public health achievements. But to fully capitalize on the potential of cancer screening to save lives, everyone needs to take advantage of recommended screenings to detect cancer as soon as possible.


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