Do you ever wonder if having insurance really helps you come out ahead? When I look at how much my family has paid in premiums over the years, it seems impossible that we have received benefits equal to our premiums, deductibles and out-of-pocket maximums. I tend to have what I call the Eeyore mentality when it comes to health care and figure, “Of course my premiums will increase this year and my coverage will decrease.” I’ve just come to expect it.
So it is a welcome surprise to read about an increase in coverage and benefits. This particular change will not benefit me directly, but it will help those I love, so I’m grateful. The Affordable Care Act has some new revisions that now broaden the term “preventative services” which will help make screening colonoscopies even more affordable for Medicare patients.
On January 1, the Centers for Medicare & Medicaid Services (CMS) released a preventative and screening services update that was implemented on January 5. Before this amendment, screening colonoscopies were covered, but patients could still be responsible for co-insurance and anesthesia costs. Now, CMS includes anesthesia in its definition of “colorectal cancer screening tests,” so co-insurance and deductible do not apply to anesthesia services associated with screening colonoscopies (Source: CMS.org).
This is wonderful news for Medicare patients who may not be able to afford the out-of-pocket costs associated with anesthesia and co-insurance and say “no thanks” to a colonoscopy. Now that your screening colonoscopy is no longer cost-prohibitive and you’ll be napping like Sleeping Beauty throughout your procedure, there’s no reason to delay that baseline screening anymore! Hopefully, we will see a dramatic increase in the number of screening colonoscopies in 2015 because there will be no cost-share barrier.
But wait, how does Medicare benefit from including anesthesia costs in colorectal cancer screening? We’re talking millions of dollars here.
I think we need to look at the bottom line. If Medicare patients are incentivized to have a colonoscopy, there should be fewer cases of colorectal cancer in the coming years. In the long run, it is much more cost-effective to cover anesthesia costs for a colonoscopy (the gold standard of all colon cancer screenings) than hospital costs for advanced colorectal cancer and other bowel diseases. Colorectal cancer is one of the most preventable cancers because colonoscopies can prevent, diagnose and treat colon cancer. What other procedure has so much medical capability?
Maybe, thanks to this revision, the goal of 80 percent by 2018 is even more attainable. The National Colorectal Roundtable began this initiative in hopes of eliminating colorectal cancer as a major health issue in the United States. Over 170 organizations have joined the campaign to increase colorectal screening rates to 80 percent by 2018, and I think this goal is more attainable than ever (Source: NCCRT).
Eeyore mentality, begone! Things are looking up.