Medicare Coverage Associated with Higher Cancer Screening Rates

Individuals were more likely to receive breast cancer and colorectal cancer screenings after obtaining Medicare coverage, according to a study from Epic Research.

The Affordable Care Act requires health insurance plans to cover preventative care, including cancer and chronic disease screenings. However, screening rate increases for people with private health plans have been modest, past research found.

Other studies have indicated that cancer screenings are more common at age 65 when most people become eligible for Medicare. Researchers assessed individuals between ages 60 and 70 to determine if screening rates and subsequent diagnoses increased after they started receiving Medicare coverage.

They found that colorectal cancer screenings nearly doubled when patients started Medicare coverage. Five years before a patient’s first Medicare encounter, the colorectal cancer screening rate was 4.8 percent. This figure grew to 6.0 percent one year before and rose to 11.0 percent during the year of a patient’s first Medicare encounter.

Similarly, breast cancer screenings increased by around 50 percent. The rate of breast cancer screenings rose from 15.3 percent five years before Medicare coverage to 20.5 percent one year before and finally to 30.4 percent during the year of a patient’s first Medicare encounter.

Screening rates for colorectal and breast cancer remained high beyond the first year of Medicare coverage, the study found.

Researchers also evaluated individuals to determine if diagnoses for 14 common conditions occurred more often when they started receiving Medicare coverage.

The study revealed that ten of the 14 conditions were more commonly diagnosed in the year of a patient’s first Medicare encounter compared to the five years before or after. The conditions included breast cancer, colorectal cancer, prostate cancer, lung cancer, hypertension, hyperlipidemia, coronary heart disease, type 2 diabetes, depression, and chronic obstructive pulmonary disease (COPD).

After increasing during the first year of Medicare coverage, the initial diagnosis rate for these conditions decreased in the following years. According to the study, this is likely because the conditions have associated quality measures that clinicians must report to CMS through the Quality Payment Program (QPP).

For example, the diagnosis rate for prostate cancer was 0.7 percent one year before Medicare coverage, 1.0 percent during the first year of Medicare coverage, and 0.5 percent during the year after a first Medicare encounter.

Similarly, the diagnosis rate for COPD was 3.5 percent one year before Medicare coverage, 4.3 percent during the year of a first Medicare encounter, and 2.6 percent during the following year.

Other conditions, including dementia, chronic kidney disease, heart failure, and arthritis, had higher initial diagnosis rates before Medicare coverage, as these conditions are more likely to have noticeable symptoms that prompt patients to seek care.

The COVID-19 pandemic impacted preventive care, as cancer screenings plummeted during 2020. However, Epic Research found that screening rates rebounded in 2021 and cancer diagnoses did not disproportionately increase.