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What is a Free Screening Colonoscopy?

What is a Free Screening Colonoscopy?

Colon cancer can affect anyone. If you are over 50 (45 for African-Americans) or have certain risk factors, you need to get screened.  The best way to prevent colon cancer is regular colon screenings to examine for polyps and abnormalities. The colonoscopy is the gold standard for colon screening, there are several other types of colon screening options that cost less than a colonoscopy, but the colonoscopy is still the most effective screening method available.

Under the Affordable Care Act (ACA), you may be eligible for a free or low-cost colonoscopy. Not everyone qualifies, and you have to meet specific qualifications. To help you determine whether you may qualify for a free or low-cost colonoscopy, you must answer these questions:

  • Are you on a public health program like Medicare or Medicaid OR in a private plan that started after September 23, 2010?
  • Is this a screening colonoscopy (you have no symptoms and no personal or family history)?
  • Is your colonoscopy being performed by an in-network provider?

If you answered “yes” to all of these questions, your colonoscopy should be covered without a copay, and you should contact your healthcare provider for more details. Remember that your healthcare provider may choose to cover another type of colon screening besides a colonoscopy. If you are having a diagnostic colonoscopy (where you have symptoms or a personal or family history), you may be responsible for some of the cost of the procedure.

If you have a screening colonoscopy and your doctor finds a polyp during the colonoscopy, your insurer should not impose costs for the removal of a polyp. Based on clinical practice and comments received from groups like the American College of Gastroenterology, polyp removal is an intergral part of a colonoscopy. This does not apply to Medicare patients. If you have Medicare and a polyp is found and removed during a screening colonoscopy, your deductible will be waived, but you must pay co-insurance (Source: Centers for Medicare and Medicaid Services).

All insurance holders and Medicare patients should be prepared to pay for other aspects of the procedure such as the bowel prep and transportation to and from the appointment (Source: Colon Cancer Alliance). If you are concerned about the financial aspect of a colonoscopy, there are resources that can help. No one should avoid a colonoscopy because of money. Often, free or low-cost colonoscopies are offered at the county level, so that is a good place to start.

If you would like more information about a free or low-cost colonoscopy, please contact these resources:

  1. The Center for Disease Control—Some states have colorectal screening programs, so look for one in your area.
  2. Department of Health—Contact your local department of health to inquire about colorectal cancer screenings.
  3. American Cancer Society—You can search by zip code for screening programs. Refer to the Search for Resource Page and select “Cancer Screening—Colorectal” from the Program Type drop-down menu.
  4. National Association of Community Health Centers—Find out more about the NACHC and their locations.
  5. Colonoscopy Assist—This program offers colonoscopies at discounted rates ($950) for underinsured individuals in select cities. Some regions may provide free colonoscopies where funding is available.

Specific coverage and assistance may vary from state to state. Each state chooses its own benchmark plan, and this plan dictates what insurance is required to cover in your state. You can have a voice in your own health care. Contact your state insurance commissioner, governor or legislature to share your feedback about the need for free and low-cost colonoscopies. 

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posted on March 14, 2014 in news