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. Author manuscript; available in PMC: 2021 Jun 24.
Published in final edited form as: J Cancer Policy. 2021 Feb 16;28:100275. doi: 10.1016/j.jcpo.2021.100275

Table 1.

Abridged Affordable Care Act (ACA) Policies Relating to Cancer Coverage.

Condition Affordable Care Act (ACA) P.L. 111–148 [3] statement (Abridged) ACA HealthCare.gov website [10] preventive services description ACA HealthCare.gov website [10] interventions covered
Breast and ovarian cancer SEC. 2713 (a). Group health plans and insurers shall not impose cost sharing requirements for evidence-based items or services that: have an ‘A’ or ‘B’ rating from the USPSTF; or with respect to women, are provided for in HRSA comprehensive cancer guidelines; or that fit with USPSTF recommendations on breast cancer screening, mammography, and prevention The Affordable Care Act covers mammograms for women over age 50–74; and requires health insurance plans to cover these services for women at higher risk of breast cancer:

  • Counseling about BRCA genetic testing

  • Counseling about breast cancer chemoprevention

 For women only:

  • Screening mammography

  • BRCA1/2 genetic counseling

  • BRCA1/2 genetic testing where indicated

  • Breast cancer chemoprevention counseling
Colorectal cancer SEC. 2713 (a). Group health plans and insurers shall not impose cost sharing requirements for evidence-based items or services that: have an ‘A’ or ‘B’ rating from the USPSTF SEC. 4104. Medicare. The amount paid will be 100 percent for the services under this part. … included in the initial preventive physical examination Under the Affordable Care Act, most insurance plans must cover screening for colorectal cancer for persons age 50–75. The physician helps decide which test is appropriate and how often to get screened. Some tests are done every 1–3 years; others every 5–10 years. The ACA website does not list specific colorectal diagnostic interventions. USPSTF recommendations:

  • Screening fecal occult blood test

  • Screening fecal immunochemical test

  • Screening colonoscopy

  • Screening flexible sigmoidoscopy
Prostate cancer SEC. 4103. Section 1861 of the Social Security Act is amended by adding a new subsection on the Medicare Annual Wellness Visit that contains a list of risk factors and conditions identified through an initial preventive physical examination, and a screening schedule for the next 5–10 years The ACA Preventive Services website does not specifically list prostate cancer. Medicare covers digital rectal examination in men over 50 (20 % copay after yearly Part B deductible).

  • Digital rectal examination