Most cancer screenings are covered by insurance at no cost to you. Under the Affordable Care Act, private health plans must cover recommended cancer screenings with zero copays, coinsurance, or deductible requirements. Medicare covers a similar list of screenings. The details, however, depend on your age, the type of cancer, and the specific plan you carry.
What the ACA Requires
The ACA requires most private health insurance plans to cover preventive services, including cancer screenings, at no out-of-pocket cost when you use an in-network provider. This applies to plans purchased through the marketplace and most employer-sponsored plans. The screenings that qualify for this $0 coverage are those recommended by the U.S. Preventive Services Task Force (USPSTF) with an A or B grade.
The cancer screenings currently covered at no cost under most private plans include:
- Breast cancer: Mammograms every two years for women ages 40 to 74
- Cervical cancer: Pap tests starting at age 21, with various testing options through age 65
- Colorectal cancer: Screening for adults ages 45 to 75, using colonoscopy, stool-based tests, or other approved methods
- Lung cancer: Low-dose CT scans for adults ages 50 to 80 who have a significant smoking history
One important exception: grandfathered health plans are not required to offer free preventive care. These are plans that existed before March 23, 2010, and haven’t made significant changes to benefits or costs since then. If you have a grandfathered plan through your employer, your cancer screenings may come with copays or coinsurance. Your plan documents or insurance card should indicate whether your plan is grandfathered.
What Medicare Covers
Medicare Part B covers a broad set of cancer screenings at no cost when you see a provider who accepts Medicare assignment. The covered screenings include mammograms, cervical and vaginal cancer screenings, colorectal cancer screenings (colonoscopies, stool DNA tests, fecal occult blood tests, CT colonography, and flexible sigmoidoscopies), lung cancer screenings, and prostate cancer screenings. For prostate cancer, Medicare covers a PSA blood test and digital rectal exam once a year for men age 50 and older.
What you owe can change depending on whether your provider accepts assignment, whether you have supplemental insurance, and, critically, whether your screening stays classified as a “screening” rather than a “diagnostic” procedure. More on that below.
Screening by Cancer Type
Breast Cancer
The USPSTF recommends mammograms every two years for all women starting at age 40 through age 74. Because this carries a B recommendation, ACA-compliant plans cover it at $0. Medicare also covers screening mammograms. If you’re at higher risk due to family history or genetic factors, your doctor may recommend starting earlier or screening more frequently, though additional imaging like breast MRI may have different coverage rules depending on your plan.
Cervical Cancer
For women ages 21 to 29, the recommendation is a Pap test every three years. Starting at age 30 through 65, you have options: an HPV test every five years, a combined HPV and Pap test every five years, or a Pap test alone every three years. All of these are covered at no cost under ACA-compliant plans. The American Cancer Society recommends starting with HPV testing at age 25, but insurance coverage follows the USPSTF guidelines.
Colorectal Cancer
Screening starts at age 45 for people at average risk and continues through age 75. Several test options are covered, each on a different schedule: a stool blood test (FIT or gFOBT) every year, a stool DNA test every three years, a flexible sigmoidoscopy every five years, a CT colonography every five years, or a colonoscopy every ten years. If a stool test or sigmoidoscopy comes back positive, you’ll need a follow-up colonoscopy to complete the screening process.
Lung Cancer
Lung cancer screening with a low-dose CT scan is covered if you meet specific criteria. Under Medicare, you must be between 50 and 77, have a smoking history of at least 20 pack-years (roughly a pack a day for 20 years), and either currently smoke or have quit within the last 15 years. You also need to have no symptoms of lung cancer and get an order from your doctor. ACA-compliant private plans cover a similar population, extending the age range to 80.
Prostate Cancer
Prostate cancer screening is a bit different. The USPSTF does not give PSA testing a blanket recommendation for all men, which means it isn’t automatically covered at $0 under all ACA plans. However, many states have passed their own laws requiring private insurers to cover PSA tests and digital rectal exams. Medicare covers both once a year for men 50 and older. If you have Medicaid, coverage depends on your state and how you qualified for the program.
The Screening vs. Diagnostic Trap
This is one of the most common sources of surprise medical bills related to cancer screening. When you schedule a colonoscopy as a routine screening, it’s covered at $0. But if the doctor finds and removes a polyp during the procedure, some insurers have historically reclassified the colonoscopy as “diagnostic” rather than “screening.” That reclassification means the procedure is suddenly subject to copays and deductibles.
For Medicare beneficiaries specifically, if a colonoscopy results in a biopsy or polyp removal, you may be charged 15% coinsurance and possibly a copay. This can turn a procedure you expected to be free into a bill of several hundred dollars. Before scheduling a colonoscopy, it’s worth calling your insurer to ask how they handle polyp removal during a screening visit. Some states and newer federal guidance have pushed to close this loophole, but it still catches people off guard.
Genetic Testing for Cancer Risk
Genetic testing for mutations that increase cancer risk, such as BRCA1 and BRCA2 testing for breast and ovarian cancer, is covered by many plans, but only when it’s considered medically necessary. This typically means you need a personal or family history that puts you at elevated risk. Medicare covers BRCA testing when a provider determines it’s reasonable and necessary for diagnosis or treatment decisions, including determining eligibility for certain targeted therapies in patients already diagnosed with ovarian cancer.
If you don’t meet the medical necessity criteria, genetic testing may not be covered, and out-of-pocket costs for comprehensive panels can run into the thousands. The USPSTF does recommend genetic counseling and BRCA testing for women whose family history suggests increased risk, which means ACA-compliant plans should cover it at no cost for those who qualify.
What Could Affect Your Coverage
Even with strong federal protections, a few factors can change what you actually pay. Using an out-of-network provider can eliminate the $0 cost-sharing guarantee, even for a covered screening. Getting screened outside the recommended age range or frequency (say, a mammogram at age 35 without a specific risk factor) may not qualify as a covered preventive service. And short-term health plans, health sharing ministries, and grandfathered plans are not bound by ACA preventive care rules.
If you’re unsure about your specific plan, the most reliable step is to call the member services number on your insurance card and ask whether the exact screening you’re planning is classified as preventive and covered at no cost. Getting this confirmed before the appointment can prevent billing surprises afterward.