On May 18, 2021, the US Preventive Services Task Force (USPSTF) issued a final recommendation on screening for colorectal cancer, which recommends that screening start at age 45. The USPSTF previously recommended that these screenings begin at age 50. The USPSTF also issued an accompanying press release.

Under the Affordable Care Act (ACA), group health plans and health insurers must provide first-dollar coverage for evidence-based items or services, including various types of screenings (such as colorectal cancer screenings), with a rating of "A" or "B" under current recommendations from the USPSTF, an independent panel of scientific experts (see Practice Note, Preventive Health Services Under the ACA, Other Than Contraceptives: Covered Preventive Services).

The USPSTF's final recommendation applies to asymptomatic adults 45 years or older who do not have an elevated risk of colorectal cancer due to either:

Specifically, the USPSTF recommends offering screening for adults aged 45 to 49 years (B recommendation) and adults aged 50 to 75 years (A recommendation). The USPSTF has concluded that screening in adults aged 76 to 85 years should be an individual decision (C recommendation) and screening should be discontinued after age 85.

This final recommendation replaces the USPSTF's 2016 final recommendation on screening for colorectal cancer, which:

The USPSTF recommendation applies to stool-based and direct visualization screening tests (including colonoscopies), but does not apply to serum tests, urine tests, or capsule endoscopy for colorectal cancer screening. To learn more about the coverage requirements for colonoscopies and related services, see Practice Note, Preventive Health Services Under the ACA, Other Than Contraceptives: Colonoscopies and Related Services.

Plan administrators of non-grandfathered health plans will want to note the updated USPSTF on screening for colorectal cancer, which draws in a significant swath of middle-aged adults. As noted, plans must provide first-dollar coverage for preventive health services with an "A" or "B" rating under the USPSTF's current recommendations. And certain services relating to a preventive colonoscopy (for example, anesthesia services) also must be covered without cost-sharing—though subject to reasonable medical management techniques (see Practice Note, Preventive Health Services Under the ACA, Other Than Contraceptives: Use of Reasonable Medical Management).

In addition, on May 25, 2021, the USPSTF published a final recommendation (and related press release) that clinicians offer pregnant women behavioral counseling interventions to help them support a healthy weight and prevent excess weight gain in pregnancy (B recommendation). Plan administrators of non-grandfathered health plans will want to note this recommendation, as well.