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Fortunately, Angelina Jolie Isn't On Medicare

Margaret Dick Tocknell, for HealthLeaders Media, May 22, 2013

The Medicare Way
While the guidelines under private coverage may be solid, the same can not be said of Medicare or Medicaid.

Medicare does not have a local or national coverage decision for BRCA testing and instead relies on a patchwork of policies that may be implemented at the discretion of local contractors, according to a spokesperson for the Centers for Medicare & Medicaid Services. I was told, "…as for BRCA tests, they really are not local options for screening. Local contractors may cover them for diagnosis or to guide treatment only." 

The prophylactic mastectomy is classified as a preventive surgery and is "generally not covered whether at the local or national level," the CMS spokesperson explained.

But isn't healthcare reform supposed to be largely about prevention? The Patient Protection and Affordable Care Act includes a list of preventive services that it expects private insurers to cover without a co-pay or deductible. According to FORCE, an advocacy group for cancer patients, HHS has clarified that genetic counseling for inherited breast and ovarian cancer risk and BRCA testing fall under this policy.

Granted, the PPACA applies to private insurers and not to Medicare, but the clarification seems to confirm the importance of BRCA testing. Still, CMS tells me that the agency is not contemplating a national coverage decision for BRCA tests for screening or mastectomies for prevention.

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3 comments on "Fortunately, Angelina Jolie Isn't On Medicare"


Laurie (6/1/2013 at 6:30 PM)
@Grandma, I believe age is a risk factor for breast cancer in general. But, hereditary cancer is a different category [INVALID] tied to cancer at a young age (e.g., like Jolie's mother). This could be a legitimate reason why Medicare doesn't cover the prophylactic measures for BRCA gene positive women [INVALID] they should be done long before she reaches Medicare age, and, presumably, she's also likely to get that type of breast cancer before then as well.

Grandma (5/27/2013 at 12:25 AM)
Donald Stumpp, are you a doctor? Obviously not! The chances of a woman getting breast cancer gets greater as she gets older. Who are you to say Medicare shouldn't pay for the surgery? That is the insurance plan we have paid into all our lives and still pay a monthy premium for it.

donald stumpp (5/23/2013 at 11:23 AM)
Medicare should not pay for this surgery. By the time a women reaches age 65, if she has not developed breast cancer, what are the chances she will? It's the 37 yr old like Jolie that have a cost/benefit to testing and treatment. Her chances were very high. Additionally, the women with BRCA who are concerned like Jolie should act prior to 65, so there is no need again for Medicare to cover.