Health care reform changes make colonoscopy more affordable

Mar 9 2011

To encourage adults age 50 and older to get a colonoscopy, experts at The University of Texas MD Anderson Cancer Center highlight resources and health care reform changes that now make this lifesaving exam more affordable.

"These resources are important because regular screening is the best way to find colorectal cancer early — or even prevent it altogether," says Therese B. Bevers, M.D., medical director of the Cancer Prevention Center at MD Anderson.

Some of health care reform's cost-saving changes are already in place. Others will slowly be rolled out over the next few years.

Here is MD Anderson's advice on taking advantage of what is currently available.

Colonoscopy coverage for the insured
How can health care reform help insured men and women who have a pricey colonoscopy co-pay?

The answer depends on what kind of health insurance they have.

Have an individual or work insurance plan that started on or after September 23, 2010? Health insurance policies that fall in this category must cover a long list of preventive services, including colorectal cancer screening.

But, you may need to see an in-network doctor to get these services with no out-of-pocket costs. And, coverage for some services may depend on your age, risk factors and screening guidelines.

Have an individual or work insurance plan that started before September 23, 2010? If the policy hasn't changed much, it may be "grandfathered." So, it may or may not cover prevention services, like the colonoscopy.

But, it also can't get rid of any prevention services covered on March 23, 2010 or raise rates too much. If it does, it becomes a "new" plan, complete with free prevention services such as the colonoscopy.

Ask your insurance provider if your policy is grandfathered. Insurance companies are required to share this information.

Virtual colonoscopies aren't included in the health care reform coverage changes. So, if you'd prefer to have this exam instead of a traditional colonoscopy, check with your insurance provider to find out exactly what your policy covers. Not all providers cover virtual colonoscopy costs.

Have Medicare?
As of January 1, 2011, Medicare co-pays for many prevention services — including colonoscopies — have been eliminated.

Resources for the under-insured and uninsured
State and local resources may help those without insurance, as well as those whose insurance won't cover most screening costs.

If you're uninsured or underinsured, visit the federal government's website, HealthCare.gov, to find out if you qualify for assistance. Benefits vary from state to state.

Each state's Medicaid office can also provide information about more affordable insurance options.

Also try contacting non-profit organizations. Many have programs that cover colonoscopy costs for those who qualify. Some of these programs may help cover additional costs if further tests or treatment are needed due to an abnormality discovered during the colonoscopy.

Contact the following organizations to learn about available resources:

•Colorectal Cancer Program (CDC)
•National Cancer Institute's Cancer Information Service
•Texas Cancer Information for Texas residents

"Keep in that many details of health care reform are still being hammered out," says Lewis Foxhall, M.D., MD Anderson's vice president of health policy. "But it appears that health care changes will make it less costly to get a colonoscopy."

SOURCE The University of Texas MD Anderson Cancer Center