Coverage for Lung Cancer Screening Begins January 1
Coverage with no cost sharing will be available to many at high risk of lung cancer
(December 18, 2014)
For the first time ever, starting on January 1, individuals who are at high risk for developing lung cancer may be eligible for screening at no out of pocket cost. Those who could be eligible for early detection screening without cost to them include:
- Most people with private insurance;
- Individuals who are enrolled in their state health insurance marketplaces; and
- People enrolled in state Medicaid expansion
Lung cancer is the leading cause of cancer death for both men and women in the U.S. 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.
Are you at "high risk" for lung cancer?
Individuals 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.
If you meet this high-risk criteria, the American Lung Association recommends that you talk to your doctor about screening and check with your health insurance provider to see if your coverage includes screening.
Will you be covered at no cost?
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 this chart to help explain lung cancer screening coverage.
How can someone find out if their insurance will cover screening without additional out-of-pocket costs?
The American 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.
Does Medicare Cover Lung Cancer Screening?
Medicare, which provides health care 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. A final coverage announcement on coverage for Medicare patients is expected in February.
What other lung cancer resources are available from the American Lung Association?
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.
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 our website.
Do you want to quit smoking?
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 been helping people quit smoking for over 40 years. We believe anyone can quit and we have the tools and resources to help smokers quit for good.