Komen Colorado evaluates whether state laws and regulations regarding private health insurance plans sold meet the needs of breast cancer patients and survivors. Komen Colorado also assesses whether Health First Colorado, Colorado’s Medicaid program, administers the program to ensure sufficient coverage for breast cancer patients and survivors.
Things we evaluate:
- Whether health insurance plans comply with federal and state laws; plans should include:
- No co-pays or other cost-sharing for screening mammography
- No co-pays or other cost-sharing for genetic counseling and testing for high-risk individuals
- No co-pays of other cost-sharing for preventive care identified by the U.S. Preventive Services Task Force
- Parity in cost-sharing for anti-cancer medication regardless of whether it is administered intravenously or orally
- Coverage for reconstructive surgery after mastectomy in compliance with the 1998 Women’s Health and Cancer Rights Act
- The scope of coverage for health insurance plans:
- Do plans cover diagnostic procedures, surgery, chemotherapy, radiation, and adjuvant therapy?
- Is fertility assistance covered if treatment would affect a breast cancer patient’s fertility?
- Which covered benefits are subject to deductibles, co-pays, or other cost-sharing arrangements? How does that affect affordability of care?
- Are there breast cancer specialists within a reasonable distance in the health insurance network?
Actions we’ve done to support this work:
- In 2016, Komen Colorado submitted comments to both Colorado’s Division of Insurance and Health First Colorado regarding whether health insurance provider networks were adequate to meet breast cancer patients’ needs.
- In 2015, Komen Colorado and Komen Colorado South submitted comments to Colorado’s Division of Insurance regarding the baseline level of coverage that Colorado should accept for commercial health insurance plans sold beginning in 2017.
- In 2014, Komen Colorado submitted comments regarding the baseline coverage for women’s health benefits for individuals who use Medicaid as their form of Insurance to the Colorado Department of Health Care Policy & Financing.