Cervical Cancer: Prevention and Early Detection

+ -Text Size

TOPICS

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. You can find out the date your insurance plan started by contacting your health insurance plan administrator. If your plan started on or after September 23, 2010, it’s required to cover the recommended cervical cancer screening tests. If your plan started before September 23, 2010, it may still have coverage requirements mandated by your state, but each state is different.

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.

States with laws requiring coverage of cervical cancer screening (March 2011)

    State

    Private Insurance

    Other*

 

    Alaska

    Annual Pap test for persons age 18 and over

    Co-pay, deductibles, and/or co-insurance may apply

    California

    Annual Pap test, pelvic exam, and HPV testing

    Need referral of patient's health care provider

    Co-pay, deductibles, and/or co-insurance may apply

    Colorado

    Does not specify

    Co-pay, deductibles, and/or co-insurance may apply

    Delaware

    Annual Pap test for persons age 18 and over

    Co-pay, deductibles, and/or co-insurance may apply

    District of Columbia

    Annual Pap test

    More frequent tests if recommended by a physician

 

    Georgia

    Annual Pap test

    Need referral of patient's health care provider

    More frequent tests if recommended by a physician

    Co-pay, deductibles, and/or co-insurance may apply

    Illinois

    Annual Pap test

 

    Kansas

    Annual Pap test

    Need referral of patient's health care provider

    Co-pay, deductibles, and/or co-insurance may apply

    Louisiana

    Annual Pap test

 

    Maine

    Annual Pap test and pelvic exam

    Need referral of patient's health care provider

 

    Maryland

    Covers HPV testing only, according to ACOG Guidelines (see below)

    Co-pay, deductibles, and/or co-insurance may apply

    Massachusetts

    Annual Pap test for persons age 18 and over

 

    Minnesota

    Cover Pap test when ordered by doctor according to standard practice

 

    Missouri

    Cover Pap test and pelvic exam according to ACS guidelines (see below)

    Co-pay, deductibles, and/or co-insurance may apply

    Nevada

    Annual Pap test for persons age 18 and over

 

    New Jersey

    Cover Pap test every 2 years for persons 20 and over

    More frequent testing if recommended by a doctor

    Need referral of patient's health care provider

    Certain specified HMOs must only offer and not provide coverage

    New Mexico

    Cover Pap test, pelvic exam, and HPV testing for persons age 18 and over

    Medical standards determine how often testing should be done

    Need referral of patient's health care provider

    Co-pay, deductibles, and/or co-insurance may apply

    New York

    Annual Pap test and pelvic exam for persons age 18 and over

    Co-pay, deductibles, and/or co-insurance may apply

    North Carolina

    Cover Pap test and HPV testing according to ACS guidelines (see below) or those established by the NC Advisory Committee on Cancer Coordination and Control

    Co-pay, deductibles, and/or co-insurance may apply

    Ohio

    Cover Pap test

 

    Oregon

    Annual Pap test and pelvic exam for persons age 18-64

    More frequent testing if recommended by a doctor

 

    Pennsylvania

    Cover Pap test and pelvic exam according to ACOG Guidelines (see below)

 

    Rhode Island

    Cover Pap test according to ACS Guidelines (see below)

 

    South Carolina

    Annual Pap test

    More frequent testing if recommended by a doctor

    Need referral of patient's health care provider

    Co-pay, deductibles, and/or co-insurance may apply

    Texas

    Annual Pap test and HPV test when done at the same time, for persons age 18 and over, according to ACOG (or similar national organization) Guidelines (see below)

 

    Virginia

    Annual Pap test

 

    West Virginia

    Annual Pap test and HPV testing for persons age 18 and over, according to ACOG Guidelines or USPSTF Recommendations (see below)

    Co-pay, deductibles, and/or co-insurance may apply

    Wyoming

    Cover Pap test and pelvic exam

    Co-insurance may apply

*Laws on coverage may vary slightly from state to state, so check with your insurer or your state government to see what is covered. Note that state laws don’t affect self-insured (self-funded) health plans.

American College of Obstetricians and Gynecologists (ACOG) Guidelines: Cervical cancer screening should begin at 21. Guidelines for subsequent screening differ based on age, type of screening test, and prior test results.
American Cancer Society (ACS) Guidelines: Cervical cancer screening should begin at 21 years of age. Guidelines for subsequent screening differ based on age, type of screening test, and prior test results.
United States Preventive Services Task Force (USPSTF) Recommendations: The USPSTF strongly recommends screening for cervical cancer in women who have been sexually active and have a cervix beginning at age 21.
Source: National Cancer Institute: State Cancer Legislative Database Program, Bethesda, MD. 2011.

Self-insured plans

Self-insured or self-funded plans are not regulated at the state level and do not have to follow state laws about cervical cancer screening. But they are governed by the Affordable Care Act (ACA), so most are required to cover cervical cancer screening. The exception is any self-insured plan that was in effect before 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 often larger employers which pay employee health care costs from their own funds, even though they usually contract with another company to track and pay claims. You can find out if your health plan is self-insured by contacting your insurance administrator at work or reading your Summary of Plan Benefits. 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 co-pay, 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.

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.

You can learn more about this program in our document called National Breast and Cervical Cancer Early Detection Program.

HPV vaccine costs

It’s 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 don’t have insurance or who are underinsured.


Last Medical Review: 05/02/2013
Last Revised: 02/04/2014