Pennsylvania Health Plans Must Cover Colon Cancer Screening at 45

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Pennsylvanians with state-regulated health insurance can get colon cancer screenings at no cost starting at age 45, under a law Gov. Josh Shapiro signed on Oct. 22, WHYY reported. The previous threshold was 50.

The bill passed the legislature with bipartisan support. It applies to plans such as those sold on the Affordable Care Act marketplace, and covered screenings can include colonoscopies, stool test kits and blood tests.

What the law covers and when it starts

The measure is House Bill 1123. Trade outlet clpmag.com reported that it takes effect Dec. 21, 2026, and removes out-of-pocket screening costs for about 2 million eligible state residents.

WHYY reported that the law will apply to most state-regulated plans by 2028.

Why people under 50 were left out

The American Cancer Society moved its recommended starting age to 45 in 2018. The U.S. Preventive Services Task Force made the same recommendation in 2021, and federal agencies adopted it, so private plans had to cover screenings at no cost.

That still left state-regulated plans free to charge patients under 50 with no documented family history of colon cancer. State Rep. Pat Gallagher, D-Philadelphia, said insurers do not like paying for preventive care.

WHYY noted that colon cancer rates among people under 50 have risen rapidly in recent years.

Sponsors point to cost and personal loss

Gallagher, a lead sponsor of the bill and a colon cancer survivor, said his insurer paid close to $1 million for his care after a late-stage diagnosis. A screening colonoscopy costs insurers about $2,500 on average, he said.

Gallagher told WHYY that colon cancer "is a treatable, curable cancer if detected early."

State Rep. Jordan Harris, who represents parts of West and Southwest Philadelphia, has questioned whether the state and insurers are doing enough to prevent deaths among younger people. His wife, Tiffany Harris, died of the disease in 2024 at age 36.

At legislative hearings, he said she would likely not have been considered high risk, and that routine screening might have caught her cancer earlier.

Blood test coverage

Clpmag.com reported that the law clears reimbursement barriers for the Shield blood test, made by Guardant Health.

It described Shield as the first blood-based colorectal screening tool included in both American Cancer Society and National Comprehensive Cancer Center guidelines.

The test is intended for people 45 and older at average risk, not for high-risk groups. In a release, Guardant co-CEO AmirAli Talasaz said the law widens access, particularly in rural communities.

State Sen. Devlin Robinson said in a release published by clpmag.com that colonoscopy remains the gold standard, but "the best screening test is the one a patient completes."

The post Pennsylvania Health Plans Must Cover Colon Cancer Screening at 45 appeared first on Northeast Times.

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