How the Affordable Care Act can help you prevent cancer
Focused on Health - April 2014
by Laura Nathan-Garner and Adelina Espat
Major parts of federal health care reform legislation, known as the Affordable Care Act, are now a reality. And, you may be asking, “What’s in it for me?”
When it comes to cancer prevention, the answer is “a lot.”
“Preventive care is likely to be much more accessible,” says Lewis Foxhall, M.D., vice president for health policy at MD Anderson. “We expect more people to start visiting their doctor regularly and getting screened for cancer. We hope that this will lead to more cancers being prevented or found earlier when they can be more effectively treated.”
It also should be easier for you to get assistance if you want to improve your diet, lose weight or quit smoking — all lifestyle changes that can help prevent cancer.
Here’s how health care reform supports cancer prevention.
Getting affordable health insurance is easier
Skipping routine checkups and cancer screening exams because you don't have decent health coverage? That should change. Under the health care law, insurers are required to cover certain preventive services at no out-of-pocket cost to you.
With college graduates entering the job market, only about 30% of young adults have health insurance. Health care reform helps some in this group get health insurance by allowing them to be covered by a parent’s policy until they turn 26.
As of January 1, 2014, many more people have access to health insurance through:
- Employer sponsored health plans
- Expanded Medicaid coverage in some states
- Subsidized health plans offered by Health Insurance Marketplace (federal- or state-run marketplaces where individuals and small businesses can purchase affordable health insurance)
Some people may also get help with out-of-pocket health related costs
Cancer prevention services and screenings are more affordable
For many people, it’s going to be much less costly to get cancer screening exams and adopt healthy habits that reduce cancer risks. Health insurance plans must provide recommended preventive services — without requiring a co-pay, coinsurance or a deductible.
Have an individual or work insurance plan that started on or after September 23, 2010?
Your plan must cover these cancer prevention and screening services:
- Breast cancer chemoprevention counseling
- Colorectal cancer screening
- Nutrition counseling for those with higher chronic disease risk
- Obesity screening and counseling
- Immunizations, including the Human Papilloma Virus (HPV) vaccine
- Pap tests
- HPV tests
- Smoking cessation help
- Wellness visits
- Other preventive services recommended by the United States Preventive Services Task Force
Your plan may require you 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 your policy hasn't changed much, it may be “grandfathered.” So, it may or may not cover the prevention services listed above. But, it also can’t get rid of any prevention services covered on March 23, 2010 or raise your rates too much. If it does, it becomes a “new” plan, complete with free prevention services.
Ask your insurance provider if your policy is grandfathered. They’re required to tell you.
Medicare must provide prevention and screening services with no out-of-pocket costs, including:
- Colorectal cancer screenings
- Nutrition therapy services
- Obesity screenings and counseling
- Pap tests and pelvic exams
- Prostate cancer screening (except digital rectal exams)
- Smoking cessation help
- Yearly wellness visit and preventive care exams
Some state Medicaid programs have expanded their coverage to include offer free or low-cost prevention. And if you don’t qualify or can’t afford any health plan, you can get low-cost health care at a nearbycommunity health center. So, it should be easier to get cancer screening exams, vaccines and other prevention services.
Keep in mind that the role out of the Affordable Care Act is a work in progress and details of the program may change over time. “The good news is that health care reform helps make wellness and prevention top priorities,” Foxhall says. Stay informed at www.healthcare.gov.
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