There are a lot of different kinds of cancers to be aware of as you age, and preventative screenings are important. Fortunately, your TRS-Care Medicare Advantage plan provides coverage for various cancer-related screenings and health care services.
What Cancer Screenings are Covered?
Your plan covers a variety of preventative screenings related to different kinds of cancer including breast cancer, cervical cancer, prostate cancer, lung cancer, and colorectal cancer.
How each screening is covered and how often you can get them vary. Coverage may also be dependent on you meeting specific conditions. The following are a list of some of the preventative screenings for cancer that your plan will cover.
Breast Cancer Screenings (Mammograms) Covered Services Include:
- One baseline mammogram between the ages of 35 and 39
- One screening mammogram every 12 months for women age 40 and older
- Clinical breast exams once every 24 months
There is no coinsurance, copayment or deductible for covered screening mammograms.
Cervical and Vaginal Cancer Screening Covered Services Include:
- For all women: Pap tests and pelvic exams are covered once every 24 months
- If you are at high risk of cervical or vaginal cancer or are of childbearing age and have had an abnormal Pap test within the past three years: one Pap test every 12 months
- For asymptomatic women between the ages of 30 and 65: HPV Testing once every five years, in conjunction with the Pap test
There is no coinsurance, copayment or deductible for Medicare-covered preventive Pap and pelvic exams.
Prostate Cancer Screening Covered Services Include:
For men aged 50 and older, covered services include the following - once every 12 months:
- Digital rectal exam
- Prostate Specific Antigen (PSA) test
There is no coinsurance, copayment or deductible for an annual PSA test. Diagnostic PSA exams are subject to cost sharing as described under Outpatient Diagnostic Tests and Therapeutic Services and Supplies in your Evidence of Coverage that is available on your member site retiree.uhc.com/TRS-CareMA.
Screening for lung cancer with low dose computed tomography (LDCT)
For qualified individuals, a LDCT is covered every 12 months.
Eligible members are people aged 50 – 77 years who have no signs or symptoms of lung cancer, but who have a history of tobacco smokingof at least 20 pack-years and who currently smoke or have quit smoking within the last 15 years. They must receive a written order from a physician or qualified non-physician practitioner for LDCT during a lung cancer screening counseling and shared decision-making visit that meets the Medicare criteria for such visits. There is no coinsurance, copayment, or deductible for the Medicare-covered counseling and shared decision-making visit or for the LDCT.
For colorectal cancer the following screening tests are covered:
Colonoscopy has no minimum or maximum age limitation and is covered once every 120 months (10 years) for patients not at high risk, or 48 months after a previous flexible sigmoidoscopy for patients who are not at high risk for colorectal cancer. A colonoscopy is also covered once every 24 months for high-risk patientsafter a previous screening colonoscopy or barium enema (an alternative to colonoscopy and sigmoidoscopy for high-risk patients). The following are also covered:
- Screening fecal-occult blood tests for patients 45 years and older: Once every 12 months.
- Multitarget stool DNA for patients 45 to 85 years of age and not meeting high risk criteria: Once every three years.
- Blood-based Biomarker Tests for patients 45 to 85 years of age and not meeting high risk criteria: Once every three years.
Colorectal cancer screening tests include a follow-up screening colonoscopy after a Medicare covered noninvasive stool-based colorectal cancer screening test returns a positive result.There is no coinsurance, copayment, or deductible for a Medicare-covered colorectal cancer screening exam, excluding barium enemas, and colonoscopy. There is no coinsurance, copayment or deductible for each Medicare-covered barium enema.If you have a prior history of colon cancer, or have had polyps removed during a previous colonoscopy, ongoing colonoscopies are considered diagnostic and are subject to cost-sharing as described under the outpatient surgery cost sharing described in your Evidence of Coverage that is available on your member site: retiree.uhc.com/TRS-CareMA.
Therefore, the colonoscopy screening benefit is not available for members who have signs or symptoms prior to the colonoscopy. A colonoscopy or sigmoidoscopy conducted for polyp removal or biopsy is a surgical procedure subject to the outpatient surgery cost sharing described in your Evidence of Coverage that is available on your member site: retiree.uhc.com/TRS-CareMA.
Resources for TRS-Care Medicare
If you need help finding a provider or have questions about your benefits, please call UnitedHealthcare at 1-866-347-9507, TTY 711, 7 a.m.–6 p.m. CT, Monday–Friday. You can also search for providers online by signing in toretiree.uhc.com/TRS-CareMproviA.