The Affordable Care Act specifies that all insurers, including Medicare, will pay for cancer screening tests given an A or B rating by the US Public Services Task Force (USPSTF). That almost certainly means that they will not pay for cancer screening not recommended by the USPSTF, and that will come as a surprise to many patients because the USPSTF tends to be more conservative than other organizations in its recommendations.
Some patients will find that screening tests their insurers have been paying for will no longer be covered. No screening test for prostate cancer or melanoma made the cut, so PSAs and skin checks probably will no longer be covered. On the other hand, the USPSTF recently endorsed for the first time annual low-dose CT screening for lung cancer in patients 55-79 years old with a 30-pack-year smoking history who still smoke or only quit within the past 15 years.
The USPSTF recommendations are evidence-based, and the quality of the evidence is graded A-D or labeled as an I statement (I for insufficient evidence, presumably). The recommendation for screening for skin cancer, for example, is that the evidence is insufficient to assess the balance of benefits and harms of a whole-skin examination by a primary care provider or a self-examination by the patient. Annual skin checks by dermatologists, which some insurers cover now, apparently are not even worth considering. Too harmful or too expensive, I wonder?
The USPSTF makes recommendations for non-cancer screening as well, and I assume those will also determine what insurers will pay for. The USPSTF does not recommend screening older adults for vision or hearing impairment. That could be more harmful than beneficial? I fear that the evidence may be insufficient to balance the benefits and harms of a lot of common practices, including a physical examination and walking through the door of a doctor’s office. I am sure we will hear more about all of this, possibly even in future issues of The Medical Letter.