Avoid Cancer with Health Care Reform

Focused on Health - October 2010

by Laura Nathan-Garner

Several parts of federal health care reform legislation 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. More affordable health insurance options are now available for:

• Kids with pre-existing conditions, such as asthma or autism
• Adults with pre-existing conditions, such as heart disease or diabetes
• Adults who retire before age 65
• Cancer survivors

With college graduates entering a weak 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.

Starting in 2014, most people will have access to health insurance through:

• Expanded Medicaid access
• Subsidized health plans offered by Health Insurance Exchanges (federal- or state-run marketplaces where individuals and small businesses can purchase affordable health insurance)

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. Many health insurance plans must provide preventive services — without requiring a co-pay, co-insurance or a deductible.

Will your insurance cover these services? And if so, when? The answer depends on what kind of health insurance you have:

Have an individual or work insurance plan that started on or after September 23, 2010?

Your plan must cover a long list of preventive services, including:

• 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
• Smoking cessation help
• Referrals for genetic counseling and chemoprevention counseling for those with a higher breast cancer risk
• Mammograms
• Well-baby and well-child visits, which help prevent and spot cancer and cancer risk factors early

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.

Have Medicare?
Starting in 2011, Medicare will provide prevention services with no out-of-pocket costs, including:

• Mammograms
• Flexible sigmoidoscopy or colonoscopy
• Prostate cancer screening
• Pap tests
• Smoking cessation help
• Weight, body-mass index and waist measurements, which help determine if you’re at higher risk of weight and body fat-related cancers
• Medical and family history review
• Personal risk assessment

Have Medicaid?

Starting in 2013, state Medicaid programs that offer free or low-cost prevention services will get extra money as an incentive. And, community health centers are getting more funding to provide free and low-cost preventive care. So, it should be easier to get cancer screening exams, vaccines and other prevention services.

Keep in mind that many details are still being hammered out. “The good news is that health care reform makes wellness and prevention top priorities,” Foxhall says.

Related Links:

The Affordable Care Act’s New Rules on Preventative Care and You (HealthCare.gov)
Keeping the Health Plan You Have: The Affordable Care Act and “Grandfathered” Health Plans (HealthCare.gov)
Medicare and the New Health Care Law (Centers for Medicare & Medicaid Services)
Understanding the Affordable Care Act—Timeline: What’s Changing and When (HealthCare.gov)
Health Reform Source (The Henry J. Kaiser Family Foundation)