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Press Release

March 23, 2015

Contact: Matt Anderson, 212-709-1691


Affordable Care Act Requires Insurance Coverage – Without a Co-payment – of Preventative Health Care Services, Including Colon Cancer Screenings

Colon Cancer is Second-leading Cancer Killer in the United States (50,000 per Year), But More than 60 Percent of Deaths Could be Prevented by Regular Screenings

Benjamin M. Lawsky, Superintendent of Financial Services, today issued a consumer alert providing information regarding recommended colorectal cancer screening services, and the required insurance coverage of those services – without a co-payment – under the Affordable Care Act. March is national colon cancer awareness month.

According to the Centers for Disease Control (CDC), colorectal cancer is the second-leading cause of cancer-related deaths in the United States – but it is potentially treatable if detected early. If everyone over the age of 50 received regular screenings, at least 60 percent of those deaths could be avoided. Each year, more than 100,000 people in the United States are diagnosed with colorectal cancer and approximately 50,000 people die from that disease. However, despite those sobering statistics, more than a quarter of the U.S. adult population has never been screened.

Superintendent Lawsky said: “As medical experts have noted, colon cancer is the second-leading cancer killer in the United States, but it doesn’t have to be. Early screening can make all the difference in saving lives and treating this disease. We encourage all New Yorkers who are over 50 or in other high-risk groups to discuss the issue of colon cancer with their primary care physicians and obtain the recommended screenings. Consumers may not be aware that these screenings are now available virtually free-of-charge under the Affordable Care Act, making it even easier to access these services.”

Insurance Coverage of Colorectal Cancer Screenings

The Affordable Care Act requires coverage of preventive healthcare services. These preventive healthcare services, including colorectal cancer screenings, are not subject to copayments or coinsurance when performed by a participating provider and when provided in accordance with the guidelines supported by the Health Resources and Services Administration, or if the service has an “A” or “B” rating from the USPSTF. The USPSTF has assigned colorectal cancer screenings an “A” rating for adults age 50-75 and recommends the following services:

  • Fecal Immunochemical Test
  • Flexible Sigmoidoscopy
  • Colonoscopy

If you are unsure whether your policy includes the coverage described above, please check with your insurance administrator to confirm benefit coverage.

Information on Screenings

The Centers for Disease Control recommends that both men and women above the age of 50 should begin screening.  Recommended screening for average risk individuals may include any of the following:

  • High-sensitivity fecal occult blood test (FOBT), which checks for hidden blood in three consecutive stool samples; should be done every year.
  • Flexible sigmoidoscopy, where physicians use a flexible, lighted tube (sigmoidoscope) to look at the interior walls of the rectum and part of the colon; should be done every five years with FOBT every three years.
  • Colonoscopy, where physicians use a flexible, lighted tube (colonoscope) to look at the interior walls of the rectum and the entire colon; should be done every 10 years. During this procedure, samples of tissue may be collected for closer examination, or polyps may be removed. Colonoscopies can be used as screening tests or as follow-up diagnostic tools when the results of another screening test are positive.
    • Colonoscopy also is used as a diagnostic test when a person has symptoms, and it can be used as a follow-up test when the results of another colorectal cancer screening test are unclear or abnormal.
Also, the U.S. Preventative Services Task Force (“USPSTF”), recommends that men and women under the age of 50 who are at an increased risk of colorectal cancer should discuss a course of screening with their primary care physician.  The USPSTF identifies men and women at increased risk as having:

  • A personal history of colorectal cancer or adenomatous polyps
  • A personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease)
  • A strong family history of  colorectal cancer or polyps
  • A known family history of  a hereditary colorectal cancer syndrome such as familial adenomatous polyposis (FAP) or hereditary non-polyposis colon cancer (HNPCC)


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