Current Medicare policies make CRC screening unaffordable for low-income groups: 5 key insights

Current Medicare beneficiaries, particularly those in a low-income bracket, lacking supplemental insurance may not be able to afford colon cancer screening and treatment, according to a study in Gastroenterology.

The PPACA does not address certain provisions in section 1834 (d) (3) (D) of the Balanced Budget Act of 1997, thereby prohibiting Medicare from waiving the beneficiary's share of coverage for screening costs when a diagnostic procedure is needed. Thus, if a polyp or lesion is detected through a colonoscopy, the test is classified as a 'diagnostic' and includes additional costs. Of an estimated 55.5 million Medicare beneficiaries in the United States, 14 percent lacked supplemental coverage, according to a 2010 Kaiser Family Foundation survey.

Here are five key insights:

1. Medicare beneficiaries from low-income backgrounds have half the rate of screening of high-income groups.

2. A disproportionally high percentage of Medicare beneficiaries from low-income backgrounds lack the supplemental insurance needed to cover treatment after a screening during which an issue is detected.

3. Current Medicare insurance policies increase unnecessary healthcare expenditures. Medicare spent $2 billion on around 3.8 million colonoscopies in 2013, but spent $7.3 billion on CRC treatment in 2010.

4. The study authors recommend Congress waive the coinsurance and co-pay for all diagnostic procedures associated with screening, as well as the coinsurance for colonoscopies after a test in which issues are detected.

5. They also urge Congress to no longer classify screening tests as diagnostic.

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