Does Medicare Cover Lung Cancer Screenings?
Today in the United States, statistics show that most people who are diagnosed with lung cancer are over the age of 65. Even though lung cancer is still the number one cause of cancer fatalities in this country, numbers are going down as more and more people quit smoking.
While lung cancer starts in one or both lungs, it can spread to the lymph nodes or other organs. However, if it’s only present in one lung and found before metastasis occurs, lung cancer has a great chance of being cured through cancer treatments.
Your physician may order lung cancer screenings if you are at a higher risk of getting the disease. The number one risk factor is cigarette smoking, which is responsible for 80 to 90 percent of all lung cancer deaths. Other forms of tobacco use like cigars and pipes, as well as exposure to secondhand smoke, are also major risk factors. The second most dangerous risk factor for lung cancer is exposure to radon – a natural gas emitted by rock, soil, and water – that can seep into homes through cracks in their foundations.
The recommended screening test for lung cancer is a low-dose computed tomography (LDCT) scan that takes detailed images of your lungs that are later examined by your health care provider. If your physician orders this screening, your Medicare insurance should cover it if you meet specific criteria.
How does Medicare cover lung cancer screenings?
If you’re enrolled in Original Medicare Part B (medical insurance), your insurance will cover a lung cancer screening done by an LDCT scan one time every year if you meet all the following conditions:
- You’re between the ages of 50 and 77.
- You’re not experiencing symptoms or signs of lung cancer.
- You have quit smoking in the past 15 years, or you currently smoke.
- You have a history of smoking, on average, one pack of cigarettes every day for at least 20 years.
- Your physician orders the screening.
Medicare Part B pays 100 percent of the cost for an annual lung cancer screening if you are eligible based on the requirements listed above, and if the physician who orders the screening accepts Medicare assignment.
However, before your health care provider can order your first screening appointment, you must take part in a lung cancer screening consultation with your physician. At this visit, you and your physician will talk about the benefits and risks of the screening and whether it’s a good option for you.
If you have coverage with a Medicare Advantage (Part C) plan, your provider must cover all the benefits included in Original Medicare Parts A and B (at minimum). Depending on the type of Part C plan you have, you might need to plan-approved physicians and medical facilities to get coverage. You may also be required to get references for specialists from your primary care physician before making appointments. Also, you may have out-of-pocket charges for a lung cancer screening.
If you aren’t sure about coverage restrictions through your Medicare Advantage plan, call your provider for details before making an appointment for your screening.