Cervical cancer prevention and screening: Financial issues

Financial issues can play an important role in whether or not women are screened for cervical cancer. Women with lower incomes and those without health insurance are less likely to be screened.

Many states ensure that private insurance companies, Medicaid, and public employee health plans provide coverage and reimbursement for Pap test screening. The ACS supports such coverage assurances, because they remove financial barriers for women who have health insurance, but whose insurance plans previously did not cover Pap tests.

Other programs are also available to help provide financial assistance for women with lower incomes and those without insurance.

Federal law

Coverage of cervical cancer screening tests is mandated by the Affordable Care Act (ACA), but that doesn’t apply to health plans that were in place before it was passed. Most of those plans are covered by state laws, which vary by state.

State efforts to ensure coverage of cervical cancer screening for private health insurance

Twenty-six states and the District of Columbia now require private health insurers to cover annual cervical cancer screening services (see table).

A few states have also enacted laws specifically requiring managed care organizations such as health maintenance organizations (HMOs) and preferred provider organizations (PPOs) to cover cervical cancer screening.

Some states have ensured that public employee health benefit plans cover cervical cancer screening. Although Maryland does not have a statewide benefit for cervical cancer screening, they do have a unique law requiring hospitals to offer a Pap test to adult female inpatients. Nebraska has a law that requires the Department of Health to contract with health clinics of American Indian tribes to cover cervical cancer detection services. Individual state laws vary widely. Ask your health care provider what coverage is mandatory in your state

States With Laws Assuring Coverage of Cervical Cancer Screening (March 2011)

Self-insured plans

ERISA, or self-insured plans, are not regulated at the state level, and so do not have to follow state laws about cervical cancer screening. They are covered by the ACA and so most are required to cover cervical cancer screening. The exception is any self-insured plan that was in place prior to the ACA. These plans are called grandfathered, and they don’t have to provide coverage based on what the ACA says.

Self-insured plans are typically large employers. Women who have self-insured based health insurance should check with their health plans to see what cervical cancer screening services are offered.

Medicaid

By statute or agency policy, Medicaid or public assistance programs in all 50 states and the District of Columbia cover screening for cervical cancer either routinely or on a doctor’s recommendation. This coverage may or may not conform to American Cancer Society guidelines. Please check with your state Medicaid office to learn more about what services are provided for cervical cancer screening.

Medicare

Medicare provides coverage for a screening Pap test, pelvic exam, and a clinical breast exam every 2 years for Medicare beneficiaries. And if a woman is of childbearing age and has had an abnormal Pap test in the previous 3 years, or is at high risk for cervical or vaginal cancer, she would be eligible under Medicare to be covered for screening every year. This screening is provided without copay, co-insurance, or deductible as long as you go to a doctor that accepts what Medicare pays as full payment (this is called accepting assignment). Doctors that don’t accept assignment are required to tell you up front.

National Breast and Cervical Cancer Early Detection Program

All states are making cervical cancer screening more available to medically underserved women through the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). This program provides breast and cervical cancer screening to women without health insurance for free or at very little cost. The NBCCEDP attempts to reach as many women in medically underserved communities as possible, including older women, women without health insurance and women who are members of racial and ethnic minorities.

Though the program is administered within each state, the Centers for Disease Control and Prevention (CDC) provides matching funds and support to each state program.

Since 1991, the program has provided millions of screening exams to underserved women, diagnosed more than 52,000 breast cancers, more than 130,000 pre-cancerous cervical lesions, and more than 2,800 cervical cancers. These accomplishments demonstrate a truly nationwide effort. However, due to limited resources, only about 15% of all eligible women are served nationwide.

Each state’s Department of Health will have information on how to contact the nearest program participant. For more information on this program, you can also contact the CDC at 1-800-CDC-INFO (1-800-232-4636) or on the Web at www.cdc.gov/cancer/nbccedp.

If cervical cancer is detected during screening in this program, most states can now extend Medicaid benefits to these women to cover the costs of treatment.

HPV vaccine costs

It is expected that insurance plans will cover the cost of the HPV vaccine in accordance with the Federal Advisory Committee on Immunization Practices (ACIP) recommendations. ACIP has also recommended that the HPV vaccine be included in the federal Vaccine for Children (VFC) entitlement program, which covers vaccine costs for children and teens who do not have insurance or who are underinsured.