Will My Health Insurance Cover Cancer Screenings?
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Routine screenings can help find some cancers early, before symptoms appear. Many people’s first question about cancer screening is: Does health insurance cover the cost of these tests?
That answer will vary from person to person. Typically, it is based on your insurance policy. First, learn which routine screening tests you are eligible for based on your age, risk, and other individual needs. Then, check your insurance plan to learn how the tests are covered.
Here are 5 questions to help guide you:
1. What is cancer screening?
Cancer screening is a way to check for cancer before you have any symptoms. The goal is to find cancer early, before it has a chance to grow or spread. Your screening needs will depend on factors like your age, individual risk factors, and personal health history.
Currently, screening tests are available for some types of cancer, but not all. These tests include:
2. Are cancer screenings free?
The Affordable Care Act (ACA) requires most health insurance plans to cover routine cancer screenings recommended by the U.S. Preventive Services Task Force. So, if a screening is covered as preventive care, you usually do not have to pay for the test out-of-pocket.
The following screening guidelines are recommended by the USPSTF* and covered under the ACA:
- Breast cancer screening every 2 years for women aged 40-74 years old
- Regular colorectal cancer screening for adults aged 45-75 years old
- Yearly lung cancer screenings for adults aged 50-80 years old with a 20-pack/year smoking history
- Regular cervical cancer screening for women aged 21-65 years old
*These guidelines are for people with an average risk of developing cancer. It's important to talk with your doctor about which screenings may be important for you and when to get them.
A Note About Prostate Cancer Screening
The decision to get screening for prostate cancer depends on many factors, including family history, age, race, and symptoms. Discuss the risk and benefits of screening with your doctor.
Did You Know?
Prostate cancer greatly disproportionately affects African American men and those with a family history of prostate cancer. Ensure prostate cancer screening is accessible for high-risk men.
Take Action: Support the PSA Screening for HIM Act
3. If I have a hereditary cancer risk, will insurance pay for extra testing?
If you are at a higher risk for cancer, you may need different tests or more frequent screenings. It is important to choose an insurance plan that covers this additional care.
The ACA covers genetic counseling and testing for people who meet the personal or family cancer history requirements set by the USPSTF. Certain state laws also protect insurance coverage for high-risk people who often need earlier, more frequent testing. Be sure to learn about the laws in your state that may affect your coverage.
Did You Know?
Only 5%-10% of cancer cases are associated with a genetic change passed down by a biological parent.
4. Can I get cancer screening if I do not have health insurance?
If you are uninsured, you still have options when it comes to cancer screenings. There are free or low-cost screening services available through local programs or national initiatives.
To learn more, talk with your healthcare team. Ask them to connect you to these assistance programs and supportive services.
5. Does my insurance plan cover preventive cancer vaccines?
Under the Affordable Care Act, a standard health insurance plan covers the cost of most immunizations. Contact your insurance provider to learn which vaccines your insurance plan covers.
Some vaccines protect you from viruses that may increase your risk for certain cancers. Ask your doctor for more information about these vaccines.
- The hepatitis B vaccination prevents hepatitis B infection. This vaccination reduces your risk of developing liver cancer. Viral hepatitis is one of the largest risk factors for this type of cancer. Carriers of the hepatitis B virus (HBV) face up to a 100-fold increased risk of developing adult primary liver cancer.
- The HPV vaccination provides protection against human papillomavirus (HPV) infections. This vaccination reduces your risk of developing:
- Head and neck cancer
- Anal cancer
- Penile cancer
- Some gynecological cancers
Did You Know?
The human papillomavirus causes about 39,300 cases of cancer every year in the U.S., according to the Centers for Disease Control and Prevention. Among women, cervical cancer is the most common HPV-associated cancer. Among men, oropharyngeal cancers are the most common.
Still have questions about your insurance coverage for cancer screening?
- Call our Cancer Support Helpline at CSC-867-5309 (272-867-5309) or toll-free 888-793-9355. Our experienced financial navigators can work with you to assess your options for cancer-related financial assistance and help you understand insurance benefits. They also can provide tips on how to talk with your healthcare provider about the cost of care.
- Contact your insurance company to learn what types of screenings are included in your plan. They can explain the costs, if any, of each recommended screening option. It is important to advocate for yourself if you are not sure what services your plan covers.
- Talk with your healthcare provider. Your care team is always available to you. They can answer any questions about screening guidelines or insurance coverage. When you are preparing for a screening, they can also answer your questions and connect you with helpful resources. They are there to support you throughout the screening process.
Bottom Line: Cancer Screening Can Help Detect Cancer Early
Early cancer detection often leads to better outcomes and treatment experiences. Prioritize your health and wellness. Find out which routine screenings matter for you and schedule your screenings for the year. Cancer screenings can save lives — and getting one might be the most important step you take for your health this year.
Read Jan's StoryEarly detection is so important. My lump was not something I would have felt in a regular self-exam, so get your mammograms!
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