Health care reform will lead more people to seek cancer prevention and risk-reduction services

More people will likely seek cancer prevention and risk-reduction services as a result of health care reform, say experts at The University of Texas MD Anderson Cancer Center.

"By reducing or eliminating co-pays and mandating improved coverage for prevention services, health care reform promises to reduce some of the barriers to cancer screening exams and improve vaccination rates," says Ernest Hawk, M.D., M.P.H., vice president and division head for Cancer Prevention and Population Sciences at MD Anderson. "We're optimistic that more cancers may be prevented or detected early when they can be treated most effectively."

MD Anderson's Cancer Prevention Center plans to expand its facilities and prevention offerings to meet the demand for the cancer screening and prevention services that has been growing in recent years. "And, we expect to see continued growth as a result of changes under the new law," Hawk says.

Hawk anticipates that more people will visit the Cancer Prevention Center seeking individualized risk assessments, as well as assistance to improve their diet, overcome obesity or quit smoking — all lifestyle changes that can help lower a person's cancer risks.

Because of the new health care reform policies, many health insurance plans now provide these preventive services and cancer screening exams without requiring a co-pay, co-insurance or a deductible, and more will be required to cover them in the next couple of years.

The services covered — and the date when the law requires them to be covered — varies by insurance type.

Have a private insurance plan that started on or after Sept. 23, 2010?

Individual or job-related insurance plans that started on or after Sept. 23, 2010 are now required to provide preventive services with no out-of-pocket costs. The cancer preventive services these plans must cover include:

•Colorectal cancer screening
•Diet counseling for those with higher chronic disease risk
•Obesity screening and counseling
•Pap tests
•Immunizations, including the Human Papilloma Virus (HPV) vaccine
•Smoking cessation help
•Referrals for genetic counseling and chemoprevention counseling for those with a higher breast cancer risk
•Mammograms
•Well-baby and well-child visits, which help prevent and spot cancer and cancer risk factors early

These plans may require you to see an in-network doctor to get these services with no out-of-pocket costs. And, coverage for some services may depend on your age, risk factors and screening guidelines.

Have a private insurance plan that started before Sept. 23, 2010?

If your policy has not changed much, it may be "grandfathered." So, it may or may not cover the prevention services listed above. But, it also can't get rid of any prevention services you had coverage for on March 23, 2010 or raise rates too much. If it does, it becomes a "new" plan, complete with prevention coverage with no out-of-pocket costs.

Ask your insurance provider if your policy is grandfathered. Insurers are required to disclose this information.

Have Medicare?

Starting on Jan. 1, 2011, Medicare will provide cancer prevention services with no out-of-pocket costs, including:

•Mammograms
•Flexible sigmoidoscopy or colonoscopy
•Prostate cancer screening
•Pap tests
•Smoking cessation help
•Weight, body-mass index and waist measurements, which help determine if someone is at higher risk of weight and body fat-related cancers
•Medical and family history review
•Personal risk assessment

Have Medicaid?

Starting in 2013, state Medicaid programs that offer free or low-cost prevention services will get extra money as an incentive. And, community health centers are getting more funds to provide free and low-cost preventive care. So, it should be easier to get cancer screening exams, vaccines and other prevention services.

Keep in mind that many details of health care are still being hammered out. "The good news is that health care reform makes wellness and prevention top priorities," Hawk says. "These are very promising and important developments for all Americans, and particularly for the most vulnerable among us — underserved communities, who often forgo regular screenings because they're too expensive or inaccessible."