Colorectal Cancer and Health Insurance

Colon cancer is the third most common cancer in the United States, and the third most lethal in our country, as well. In 2011, it is estimated that 141,210 new cases were diagnosed and 49,380 deaths occurred as a result of colorectal cancer. The majority of cases (72 percent last year) occur in the colon, and the remaining had formed in the rectum.

This condition is important for men and women over the age of 50 to get screened for regularly. One of the better aspects, if there were to be one, of this disease, is that the cancer takes 10 to 15 years to develop once a polyp has been discovered. As long as routine exams and necessary polyp removals take place, it is possible to fight off and never develop full-on colorectal cancer.

Though the potential for acquiring a colorectal cancer occurs in both genders, it is more common among men. If you have a family history of polyps or colorectal cancer, it is more likely that you could acquire the illness. Screenings, blood work and tests are very costly if not covered by health insurance. It is very important for those with a genetic predisposition or other health risks that may lead to colorectal cancer to obtain coverage before the condition presents itself.

Colorectal cancer can be treated and prevented by lifestyle choices and medical care. This is one of the better attributes of our medical system, as cancer is a thoroughly researched disease with free tests available to any insured American. If you have been previously diagnosed with colon cancer or had polyps, you may be able to get your treatment covered by your health plan, and you will never be turned away from an insurer for health reasons.

However, there is no question you need coverage to treat or prevent the disease, as office visits with a specialist or a primary care doctor are essential, and surgery may also be in the picture.


How Colorectal Cancer Impacts Insurance: Past and Present


Health Reform & Colorectal Cancer

Anyone who has had a colorectal cancer diagnosis can no longer able be denied coverage for their condition as a result of health reform. Thanks to the Affordable Care Act, all individuals with a pre-existing condition have their pick of any insurance company across the individual private insurance market and health plans on the exchanges. Health insurance exchanges offer plans through private companies and their networks with financial assistance for qualifying applicants.

It is also required by law that everyone obtain a health plan, but for those who need an annual colonoscopy, this might not be too large a request. The ACA also approved screenings for colorectal cancer as a free and mandatory preventive benefit through all health plans. The law gives more low-income Americans coverage through Medicaid, in the states that decided to expand their programs.

This will include the previously excluded group of non-disabled adults without children whose income is at or below 138 percent of FPL, which is an annual salary of $15,415 or $1,284 per month. Finally, you can wait tables and buy health insurance! Regardless of political views, it is hard to deny the ACA has already made positive changes for individuals who have cancer by providing insurance and health care services to people with illnesses.


The individual market for health insurance was filled with people who couldn’t wait to decline an unhealthy applicant, depriving people a right to be well. Cancer was one of the biggest red flags for an instant decline in the underwriting process. Your eligibility varied based on medical records from an oncologist, the time frame and intensity of treatment and your diagnosis at the time of application.

Based on these factors, any insurer would decide according to their underwriting guidelines whether or not to approve you. This left open an area of question for individuals with colorectal cancer in their past or present: where and how to find coverage, if possible. The best way to avoid rejection was to get coverage before you were diagnosed. Easier said than done, as with most health conditions.

There were states where insurers did not have the right to turn anyone away for coverage before health reform, including Massachusetts, Vermont and New York, though premiums there were incredibly high. Now every state guarantees issue of health insurance policies and premiums are regulated by the health care law so they can only increase a certain amount each year.


Health Plan Alternatives for Colorectal Cancer

Most Americans who have reached a certain ripened age realize they can give themselves a 65th birthday present of Medicare and stay insured for the rest of their life. Whether using an Advantage plan or receiving public assistance, this is the primary source of coverage for the aged.

Colorectal cancer can start as early as a person’s late 40s, which means other types of coverage are still needed. Those who do not earn enough to support a monthly premium may apply for Medicaid, and hopefully their state is accepting enough to provide a plan. Group coverage and exchanges are also options for people with colorectal cancer aside from private individual health plans.

Employer-Sponsored Benefits

Getting coverage through the workplace is a great way to battle colorectal cancer, whether you are an employee or married to one. Typically offered to full-time workers, it is a necessary benefit to look into, as insurers can never decline an employee for group coverage based on health. You’ll probably want to purchase an individual plan while they process your application, which generally takes one to three months.

These plans are covered by a major health plan like Aetna or Cigna, and your employer and you share the premium costs. Colonoscopies and other necessary tests will be covered by your group plan, and you no longer have to worry about the plan’s overall premium increasing if you are diagnosed with colorectal cancer. Rates will never increase regardless of how sick you are under the health care law.

These plans will not refuse to cover most types of care, though it is important to check the schedule of benefits before receiving a specific type of care or visiting a certain provider. As with all types of preventive care, colonoscopies are covered for free.



If you are age 65 or older, Medicare is the main health insurance program to rely on. Provided by the government, this plan cannot turn anyone away regardless of income level, as Medicaid and Medicare work together to help low-income Americans afford insurance.

Medicare covers all the necessities of prevention, disease treatment and office visits, as well as hospital care and surgeries. As individual health insurance only covers adults up to age 65, this is a typical go-to, unless you have group coverage. Medicare will help pay for the process of diagnosing, treating and preventing colon cancers, which mainly affects the older population.



Though according to a recent study of Medicaid members who have survived colorectal cancer indicated many individuals are not receiving proper follow-up treatment, it is certainly covered by the program. While colonoscopies may be the more dreaded of procedures, it is essential to receive them as needed, especially after one has experienced polyps or cancerous growth in the past.

Medicaid covers these services for individuals with the disease and who wish to prevent it. In order to qualify, you must have a low income, according to your state’s standards. Some Medicare beneficiaries may qualify for Medicaid assistance if their income is less than or equal to the current Federal Poverty Level. Also, having children who live with you is a plus if you want to qualify for Medicaid.

Adults in some states who do not have children or a disability and are younger than 65 may not be able to receive Medicaid, but others have elected to expand their Medicaid programs and allow childless adults with low income. Find out if you qualify by visiting your state‘s public assistance section.



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Medicaid information


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Colon Cancer Information