New Law Ends a Surprise Cost for Medicare Patients

Medicare patients who have a polyp removed during a colonoscopy no longer will be on the hook for hundreds of dollars in out-of-pocket fees, thanks to a bill former President Donald Trump signed into law late last year.

After years in the making, Congress incorporated the bill — formally named the Removing Barriers to Colorectal Cancer Screening Act, but also called the “Medicare Loophole” bill — into an end-of-year legislative package.

The new law closes a costly loophole for Medicare beneficiaries.

The Affordable Care Act of 2010 requires health insurance providers to cover colorectal cancer screening, like colonoscopies, without cost-sharing for people ages 50 to 75. But a loophole meant that if a polyp was removed during a colonoscopy, it was no longer considered a screening for those on Medicare.

In turn, that meant patients who were not expecting to pay a dime for their colonoscopy suddenly could be on the hook for hundreds of dollars in costs.

The nonprofit Colon Cancer Foundation explains:

“While the 2010 Affordable Care Act ensured that Medicare fully covers preventive screening for colorectal cancer, removing a polyp found during a routine screen makes it a diagnostic procedure, which adds a cost-sharing responsibility on the patient. As a result, the patient may end up having to pay 20% of the cost for removing the polyp as co-insurance, and this surprise bill may amount to several hundred dollars …”

Under the new law, Medicare patients will no longer be required to pay coinsurance if a polyp is found and removed during a screening colonoscopy, according to the foundation. The bad news is that the law will be phased in — meaning that cost will be phased out — over eight years, starting in 2022 and ending by 2030.

Anjee Davis, president of Fight Colorectal Cancer, and Lisa Lacasse, president of the American Cancer Society Cancer Action Network, write in The Hill that the new legislation makes it easier for people to schedule a screening, knowing they will not be stuck with an expensive surprise bill.

They note that despite the fact colorectal cancer is largely preventable with screening, it is the No. 2 cancer-killer among U.S. men and women, and it disproportionately affects people of color. Colorectal cancer will kill an estimated 53,000 Americans this year.

As the pair write:

“For colon cancer, the average age at the time of diagnosis for men is 68 and for women is 72. Eliminating cost sharing for colonoscopy screenings in Medicare means more Americans will have access to this lifesaving procedure.”

For more on trimming the price of health care, check out “7 Ways Anyone Can Cut Their Health Care Costs.”