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Medicare Cost Sharing for Screening Colonoscopy
Preparing to Talk with Members of Congress about Cost Barriers to Colorectal Cancer Screening for Medicare Beneficiaries
Presented by: Camille Bonta, MHS
Call-on Congress
March 5-7, 2012
Medicare Cost Sharing for Screening Colonoscopy
• Current Medicare Law
– Colorectal cancer screenings are free, including screening colonoscopy.
– However, if polyp is removed during colonoscopy, Medicare beneficiary must pay coinsurance.
Medicare Cost Sharing for Screening Colonoscopy
• Cost Sharing Definitions
– Deductible: Amount insured has to pay out of pocket for expenses before insurer will cover the remaining costs.
– Coinsurance: Set percentage that insured must pay of the covered costs after the deductible has been reached.
Medicare Cost Sharing for Screening Colonoscopy
• Colorectal Cancer Screening Coverage and Cost Sharing History
– 1998: Medicare coverage of screening colonoscopy for high-risk individuals.
– 2001: Medicare coverage of screening colonoscopy for average-risk individuals.
Medicare Cost Sharing for Screening Colonoscopy
• Colorectal Cancer Screening Coverage and Cost Sharing History
– 2005: Deficit Reduction Act waived Medicare beneficiary deductible for colorectal cancer screening.
• However, if a polyp was removed during screening colonoscopy, beneficiary was liable for the deductible.
Medicare Cost Sharing for Screening Colonoscopy
• Colorectal Cancer Screening Coverage and Cost Sharing History
– 2010: Affordable Care Act corrected previous law. Now deductible is always waived, even if a polyp is removed during a screening colonoscopy.
Medicare Cost Sharing for Screening Colonoscopy
• Colorectal Cancer Screening Coverage and Cost Sharing History
– 2010: Affordable Care Act waives coinsurance for colorectal cancer screenings.
• Colonoscopy, Sigmoidoscopy, FOBT
– But, Medicare beneficiary must still pay coinsurance if polyp is removed during screening colonoscopy.
Medicare Cost Sharing for Screening Colonoscopy
• Fight Colorectal Cancer’s Request to Congress
– Congressional Action is Needed this Year to Correct Coinsurance Gap
• House legislation poised for introduction (H.R. ????)• Similar legislation will be needed in the Senate
Medicare Cost Sharing for Screening Colonoscopy
• Key Messages
– Current Medicare policy is confusing.– Creates disincentive to screening.– Trends in decreased colorectal cancer
incidence could stall or decline. – Coinsurance “gap” due to unintentional
oversight in the law.
Medicare Cost Sharing for Screening Colonoscopy
• Key Messages
– Screening colonoscopy is the most effective test for the prevention of colorectal cancer.
• Allows for the removal of potentially precancerous polyps during the procedure.
– Screening colonoscopy is a unique preventive service.
Medicare Cost Sharing for Screening Colonoscopy
• Parting Words
– An effective advocate ties their personal story with key messages and facts.
– Colorectal cancer prevention has a history of bipartisan support.
– Despite claims, colorectal cancer screenings are not “free” for all Medicare beneficiaries.
– Congress needs to take action this year.
Thank You!
www.FightColorectalCancer.org