Does Medicare Cover Lung Cancer Screenings?
Medicare covers a free annual preventive lung cancer screening for beneficiaries who qualify. To receive a screening, you must meet strict criteria, undergo proper counseling on the pros and cons and get tested at a qualified center.
Understanding Medicare’s Coverage of Lung Cancer Screenings
Lung cancer is the third most common cancer and the leading cause of cancer deaths in the United States.
In 2015, the U.S. Centers for Medicare & Medicaid Services began covering annual lung cancer screenings with low-dose computed tomography for beneficiaries with a history of heavy smoking.
Low-dose computed tomography is a chest CT scan, which looks for small early-stage cancers. It has less radiation exposure compared to a standard chest CT scan.
During the screening, you lie on a table and an X-ray machine uses a low amount of radiation to take images of your lungs. The scan only takes a few minutes.
Results from a 2011 National Lung Screening Trial found that people ages 55 to 74 with a history of heavy smoking are 20 percent less likely to die from lung cancer if they are screened with low-dose CT scans instead of standard screening chest X-rays.
While a low-dose computed tomography has its advantages, it also comes with downsides.
For example, while this scan reduces radiation exposure, image quality is also reduced. This can lead to an increase in false-positive results, or results that suggest a person has lung cancer when no cancer is present.
That’s why Medicare also covers lung cancer screening counseling with a shared decision-making visit so you can discuss the benefits and harms of screening with your doctor.
Who Qualifies for a Lung Cancer Screening?
Medicare coverage only includes a yearly preventive lung cancer screening for high-risk beneficiaries.
You must meet certain criteria to receive this Medicare-covered service.
- You are 55 to 77 years old.
- You don’t have signs or symptoms of lung cancer.
- You’re either a current smoker or have quit smoking within the last 15 years.
- You have a tobacco smoking history of at least 30 years, where you smoked a pack of cigarettes each day on average.
- You receive a written order from your doctor.
Prior to your preventive screening, you’ll meet with your doctor for a counseling and shared decision-making visit.
- If you meet Medicare’s eligibility requirements for a lung cancer screening.
- The benefits and harms of screening, including overdiagnosis, false-positive rates and total radiation exposure.
- Counseling on the importance of annual lung cancer screenings.
- Your ability or willingness to undergo treatment if cancer is detected.
- The importance of remaining smoke-free if you’re a former smoker or quitting smoking if you’re a current smoker.
- Information about tobacco cessation programs, if appropriate.
If a lung cancer screening is right for you, your doctor can refer you to a high-quality screening facility.
According to Harvard Medical School, you should try to schedule your screening at a center of excellence in lung cancer.
If your follow-up confirms cancer, it’s important to have a team of radiologists, surgeons and other medical professionals experienced in treating the disease.
Cost of Lung Cancer Screening with Medicare
Lung cancer screenings are one of many preventive services covered by Medicare Part B.
Medicare Advantage plans, which are administered by private insurance companies who contract with the federal government, also cover lung cancer screenings for beneficiaries who qualify.
You will owe nothing for this service so long as you continue to meet eligibility requirements.
5 Cited Research Articles
- Centers for Disease Control & Prevention. (2020, September 22). Who Should Be Screened for Lung Cancer? Retrieved from https://www.cdc.gov/cancer/lung/basic_info/screening.htm
- American Lung Association. (2020, April 14). Medicare Coverage for Lung Cancer Screening Frequently Asked Questions. Retrieved from https://www.lung.org/lung-health-diseases/lung-disease-lookup/lung-cancer/saved-by-the-scan/resources/medicare-coverage-faq
- Harvard Medical School. (2015, January). Medicare covers lung cancer screening. Retrieved from https://www.health.harvard.edu/cancer/medicare-covers-lung-cancer-screening
- Centers for Medicare & Medicaid Services. (n.d.). Decision Memo for Screening for Lung Cancer with Low Dose Computed Tomography (LDCT) (CAG-00439N). Retrieved from https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=274
- Medicare.gov. (n.d.). Lung cancer screenings. Retrieved from https://www.medicare.gov/coverage/lung-cancer-screenings