Medicare Loophole For Screening Colonoscopies Is Fixed (with Help of NJ Congressional Rep)


Colorectal cancer is estimated to kill more than 53,000 Americans this year alone. It remains the No. 2 cancer killer among men and women in the United States, and disproportionately affects people of color. But with recommended screening, this disease is preventable.

That’s one of the reasons the Affordable Care Act required that health insurance plans cover screening colonoscopies without cost sharing. But the law created a loophole when it came to Medicare coverage: if a polyp was found and removed, the procedure was no longer considered “screening” and the patient faced an unexpected charge which could amount to hundreds of dollars. The expense created a major barrier to this lifesaving screening for those who are most at risk for colorectal cancer.

With the average age of diagnosis of 68 for men and 72 for women, and since risk of colon cancer increases with age, closing this loophole can make the difference between life and death.

To address the loophole, Fight Colorectal Cancer (Fight CRC) and the American Cancer Society Cancer Action Network (ACS CAN) shared their stories with members of Congress on the importance of cancer screening and the risk this loophole posed to seniors.

For New Jersey Congressional representative Rep. Donald Payne, Jr. the fight was personal: his father, Rep. Donald Payne Sr., passed away from colorectal cancer while in office. Rep. Payne Jr. has been a sponsor and persistent champion of the bill and frequently reminds his colleagues that colorectal cancer is why he’s serving in Congress. An advocate’s personal story changes things and we hope this inspires others to keep sharing.

We are proud of the advocates who have stayed persistent to push this over the finish line. Because of their work, this bill will not only reduce suffering and death from cancer, but it will help reduce cancer disparities. Eliminating cost sharing for colonoscopy screenings in Medicare means more Americans will have access to this lifesaving procedure.

Our organizations are grateful to everyone who advocated for this bill and for our senators and representatives who co-sponsored it each year and finally were able to get it passed.

by Anjee Davis, MPPH, president of Fight Colorectal Cancer; and Lisa Lacasse, president of the American Cancer Society Cancer Action Network (ACS CAN).

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