Screening guidelines often don’t agree
One of the mandatory benefits of health insurance, thanks to Obamacare, is that preventive or screening services are covered without charging copays or coinsurance.
Preventive care is not really “free,” of course, because we pay higher premiums and higher copays and deductibles for other health care. It’s more like pre-paid.
(Oh, and make sure the doctor and testing facility (lab or radiology) are in your network, or the care won’t be covered.)
But I’ve found it more and more confusing to know which screening exams are covered, and how often, because different medical “authorities” seem to disagree.
Obamacare’s overseer, the Department of Health and Human Services (HHS), is using the guidelines published by the United States Preventive Services Task Force (USPSTF) to determine which screening tests and preventive exams should be covered. There is a long list, and any test scoring an A or B grade, indicating “high” or “moderate” certainty of benefit, will be included.
However, not all doctors and not all medical groups will necessarily agree with those guidelines.
For example, the USPSTF recommends mammograms every two years for women age 50 to 74. Yearly mammograms, or mammograms before the age of 50, might not be covered. Don’t assume they are. Check with your insurance provider.
For men, the USPSTF no longer recommends screening for prostate cancer with the PSA blood test (it only got a D grade!). Again, don’t assume it’s covered even if your doctor orders it. Check with your insurance provider.
To be safe, check your insurance policy for all routine screening and preventive tests to make sure they are covered, so you are not surprised by one or more expensive charges. Don’t trust your doctor or your doctor’s staff to know—check for yourself.
Rare consensus on Pap smears
Thankfully, there is one screening test the experts do seem to agree on—the Pap smear for cervical cancer.
Not only did the USPSTF give it an A grade, but the Centers for Disease Control (CDC), the American Cancer Society, and the American College of Obstetrics and Gynecology all agree to the same guidelines.
The CDC has also published an informative brochure about cervical cancer, human papillomavirus (HPV) and the screening tests. You can download the PDF here. Oddly, though, the brochure never makes clear how often you should get a Pap smear.
- No screening before age 21.
- Screening every 3 years between ages 21-29 with Pap smear only, no HPV testing. (The rate of incidental HPV infection is high in this age group; add HPV testing only if the Pap smear is abnormal.)
- Screening every 5 years between ages 30-65 with Pap smear and HPV testing, or every 3 years with just Pap smear.
- No screening after age 65, unless the most recent Pap smear was abnormal.
Related post: Should you get the HPV vaccine?
Here’s hoping that more health care organizations can come together and provide us consumers with clear, consistent, evidence-based and cost-effective screening guidelines.
Until that happy day, discuss your screening needs with your health care provider and don’t neglect to read the fine print of your insurance policy.