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