Regular screenings can help catch early signs of cancer so you can get the timely treatment you need. But it can be hard to figure out which screenings are recommended, how often they’re needed and what’s covered by your health plan.
We’ll answer these questions about cancer screenings and more so you’ll know what to expect and not be surprised by unforeseen costs.
Are cancer screenings covered by insurance?
Some cancer screenings are considered preventive care services. These types of services are rolled into what you already pay for your health insurance. This means no out-of-pocket costs for you, as long as you get preventive care services from an in-network doctor or clinic your plan covers.
However, for something to qualify as a preventive service, it must take place before a problem is identified. So cancer screenings may or may not be considered and billed as a preventive service depending on your health situation.
Health plans, including those from HealthPartners, do not determine which services are considered preventive care and instead must follow guidelines from several sources identified by the Affordable Care Act (ACA). This includes those with an A or B rating under the United States Preventive Services Task Force (USPSTF) guidelines. This ensures health insurance companies provide coverage the same way.
Breast, cervical and colorectal cancer screenings are covered preventive services in the A or B rated USPSTF guidelines, as are lung cancer screenings for specific people.
Other cancer screenings that aren’t listed in the USPSTF guidelines, such as prostate and skin cancer screenings, may be recommended by your doctor based on your personal health needs. Those would be covered under non-preventive parts of your plan. That may result in out-of-pocket costs.
Even when cancer screenings aren’t covered as a preventive service, as a HealthPartners member, you benefit from pre-negotiated prices with our network of clinics to minimize your out-of-pocket costs.
The American Cancer Society recommends regular screenings for breast, colorectal and cervical cancer. It also recommends lung cancer screenings for smokers and those with other risk factors that put them at a higher risk for developing lung cancer.
Guidelines for cancer screenings are a little different for everyone, so it’s best to talk to your doctor. They’ll provide recommendations and help you schedule a screening, if needed.
Breast cancer screenings
Breast cancer screening guidelines vary throughout the medical community. If you have a higher risk of developing breast cancer, your doctor might recommend starting screenings when you turn 40, but it’s generally recommended that women ages 45 to 54 get yearly mammograms. After age 55, women can choose to have a mammogram every other year, or they can continue yearly screenings. While USPSTF guidelines recommend a mammogram every other year for women ages 50 to 74, most HealthPartners plans cover screening mammograms at any age if they’re recommended by your doctor.
What you should know about mammogram coverage
A mammogram during an annual breast cancer screening is a preventive service that is covered 100% by most HealthPartners plans. But there are some scenarios you want to be aware of so you don’t run in to unexpected costs.
If something irregular is detected during your annual breast cancer screening and a second mammogram or additional follow-up care is needed, those services are no longer considered preventive, and you may have some out-of-pocket costs.
Patients with dense breast tissue may need an ultrasound or MRI instead of, or in addition to, a mammogram. The ultrasound or MRI is not considered preventive. These services would be covered under your imaging benefit and may have some out-of-pocket cost depending on your plan.
Most HealthPartners plans cover both 2D and 3D mammograms as a preventive service. Your plan documents detail your exact coverage.
Cervical cancer screenings
Pap tests and human papillomavirus (HPV) tests are used for cervical cancer screening. Women between ages 21 and 29 should get screened at least every three years, and women ages 30 to 65 should get screened at least every five years.
What you should know about cervical cancer screening coverage
Cervical cancer screenings are covered preventive services in the USPSTF guidelines. This means no out-of-pocket costs for you on most HealthPartners plans, as long as you get preventive care services from an in-network doctor or clinic your plan covers.
Colorectal cancer screenings
People with an average risk of developing colon cancer should get regular screenings between ages 45 and 75. These screenings can include different options, including a colonoscopy or a fecal immunochemical test (FIT) from the comfort of your home. There may be tests that are described as colon cancer screenings but are not considered safe and effective, and therefore they are not covered by your plan. Your doctor will let you know how often you’ll need a colon cancer screening.
What you should know about colonoscopy coverage
On most plans, a colonoscopy as a colorectal cancer screening is preventive – even if the doctor removes polyps or tissue samples during the procedure. But there are scenarios where colonoscopies are not considered preventive and may have some out-of-pocket costs, like:
- If you’re having symptoms of any kind and the colonoscopy is ordered to help with a diagnosis.
- If you have a history of colon cancer, polyps, diverticulitis, Crohn’s disease or other similar conditions.
- If additional follow-up care is needed after your initial screening colonoscopy – such as another procedure to remove additional growths or any treatments if cancer is detected – then subsequent colonoscopies are not preventive.
Additionally, some things that occur related to colonoscopies are also not covered as preventive. For example, sometimes endoscopies or sigmoidoscopies are performed at the same time as a colonoscopy. Only the colonoscopy would be covered as preventive. Colonoscopy prep work and medications are also not covered as preventive.
Lung cancer screenings
Lung cancer screenings are recommended for people aged 55 to 74 who currently smoke or have a history of smoking. Before getting screened, talk to your doctor about the risks and benefits of a screening. They’ll help you decide if it’s right for you.
What you should know about lung cancer screening coverage
For lung cancer screenings to be considered a preventive service under USPSTF guidelines, you must be an adult who is 50 to 80 years old with at least a 20 pack per year smoking history and who currently smokes or quit within the past 15 years. People who have a health condition that substantially limits their life expectancy or the ability to have curative lung surgery may no longer qualify for lung cancer screenings as a preventive service. You should review your plan coverage to confirm.
Prostate cancer screenings
Doctors are still researching how effective prostate cancer screenings are. Most men should talk to their doctor at age 50 about whether a screening is right for them. It may be recommended based on your personal health needs.
What you should know about prostate cancer screening coverage
Prostate cancer screenings are not covered as preventive services under USPSTF guidelines and would be covered under non-preventive parts of your plan. That may result in out-of-pocket costs.
Skin cancer screenings
While the American Cancer Society does not have screening guidelines for skin cancer, it’s important that everyone is familiar with their skin and does regular skin self-checks. Any changes in your skin should be examined by a doctor as soon as possible, and they will let you know if additional testing or a biopsy is needed.
What you should know about skin cancer screening coverage
Skin cancer screenings are not covered as preventive services under USPSTF guidelines and would be covered under non-preventive parts of your plan. That may result in out-of-pocket costs.
Not sure if something is considered preventive for you? Contact your insurance company.
If you have HealthPartners insurance, you can:
- Review preventive care guidelines
- Sign in to your account
Note: If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.