Individuals at High Risk Should Get Screened for Lung Cancer
Coverage with no cost sharing will be available to many at high risk starting January 1, 2015.
(December 18, 2014) - Chicago, IL
For the first time ever, starting January 1, individuals who are at high risk for developing lung cancer may be eligible for screening at no out-of-pocket cost. Most people with private insurance, individuals who are enrolled in their state health insurance marketplaces and people enrolled in state Medicaid expansion will be eligible for early detection screening without cost to them.
Patients considered to be high risk and potentially eligible for screening are 55 through 80 years of age; have a 30 pack-year history of smoking (this means 1 pack a day for 30 years, 2 packs a day for 15 years, etc.); and are a current smoker, or have quit within the last 15 years. Screening people at high risk has the potential to save more than 13,000 lives a year.
“Individuals who meet the high risk criteria should talk with their doctors about being screened,” said Harold P. Wimmer, National President and CEO. “No one deserves lung cancer and that’s why the American Lung Association is working to let everyone know that early detection screening will be available without additional out-of-pocket costs January 1 for people at high risk.”
In December 2013, the U.S. Preventive Services Task Force (USPSTF) awarded a “B” grade to annual low-dose CT screening for individuals at high risk for lung cancer. Under the Affordable Care Act, effective prevention measures – graded A or B – are included in the Essential Health Benefit. Individuals who are enrolled in state health marketplace plans, enrolled in Medicaid-expansion programs and those with non-grandfathered private insurance plans who meet the screening criteria will have insurance coverage for screening without co-payments or other barriers starting January 1, 2015 or the beginning of their next plan year. The American Lung Association has created a chart to help explain this coverage. The Lung Association also created a checklist for individuals to use when calling their insurance companies to determine if they are eligible for screening with no cost.
The American Lung Association also provides many free resources for lung cancer patients and their caregivers. Patients can determine if they are candidates for lung cancer screening through our online tool, LungCancerScreeningSavesLives.org.
Additional resources include Facing Lung Cancer: Support from Day One, a comprehensive online resource with interactive features that offers education and support to people living with lung cancer and their loved ones. The Lung Connection is an online community where individuals living with lung disease and their caregivers can discuss how lung disease affects their lives and share experiences with peers.
Medicare, which provides healthcare insurance for most Americans over the age of 65, is in the midst of a separate National Coverage Determination process to determine coverage for lung cancer screening among its beneficiaries. In November, the Centers for Medicare and Medicaid Services proposed to offer an annual low-dose CT scan for Medicare beneficiaries at high risk. A final coverage announcement from CMS is expected for Medicare patients in February.
Lung cancer is the leading cause of cancer death for both men and women in the United States. The five-year survival rate for lung cancer patients is only 17.8 percent. An annual low-dose screening test for individuals at high risk has the potential to dramatically improve lung cancer survival rates by finding the disease at an earlier, more treatable stage. The USPSTF estimates that if everyone who is at high risk is screened, there will be a 14 percent reduction in lung cancer deaths in the United States.
To increase awareness about lung cancer – from the importance of screening to treatment and support options – in May, the American Lung Association launched LUNG FORCE in May, our national movement focused on fighting lung cancer in women. Despite being the #1 cancer killer of women, only one percent of women say it’s on their radar, according to our inaugural Women’s Lung Health Barometer. LUNG FORCE is seeking to right this wrong: it’s about education, uniting women to make a difference and inspiring America to take action against the devastating disease that is lung cancer.
The most important risk factor for lung cancer is smoking, and the best thing people can do to reduce their risk is to stop smoking or never start. The American Lung Association has helped more than one million people quit smoking through its Freedom From Smoking® program and its Lung Helpline at 1-800-LUNGUSA. Information on screening and other lung cancer risk factors including exposure to secondhand smoke, radon, air pollution and other hazardous materials, can be found on the American Lung Association’s website.