CMS Updates Medicare Coverage for Lung Cancer Screenings

What’s new with Medicare and lung cancer screenings?

The Center for Medicare and Medicaid Services (CMS) has recently relaxed the eligibility requirements for Medicare lung cancer screenings. Now, more beneficiaries can receive a low-dose computed tomography (LDCT) screening for lung cancer, improving health outcomes for thousands of Americans.

According to the CMS, lung cancer is the leading cause of cancer-related death among men and women in the United States and one of the most common forms of cancer. It is most prevalent among smokers, with somewhere between 80 and 90% of cases linked to tobacco products like cigarettes, cigars, pipes, and vape pens. Even casual tobacco use can highly elevate the risk of lung disease. For this reason, the new benefit focuses heavily on current and former smokers. Here’s all the news on Medicare and lung cancer screenings.

Qualifying for a Lung Cancer Screening Test

To qualify for a lung cancer screening through Medicare, you must be asymptomatic, meet a minimum age requirement, and have a smoking history of at least 20 “pack years” (an average of one pack (20 cigarettes) per day for 20 years). You must also be a current smoker or have quit smoking within the past 15 years. Your doctor will determine if you qualify during your Welcome to Medicare visit. 

Additionally, CMS has recently lowered the minimum age for lung cancer screenings to 50 (from 55). While this change will not affect most Americans, it will allow those who enrolled in Medicare before 65 to receive earlier treatment. CMS has also reduced the yearly consumption requirement from 30 pack years to 20 pack years — an average of approximately 7,300 cigarettes per year.

Getting a Low Dose Lung Cancer Screening

A lung cancer screening involves a low-dose computed tomography (LDCT) scan: this is a type of X-ray that uses very low doses of radiation to take detailed images of your lungs. These are quick, painless, and non-invasive procedures: you may have heard them referred to as “CAT Scans” in the past. An LDCT is a newer technology, using a thin X-ray beam that rotates around your body, taking multiple cross-sectional pictures. Compared to traditional X-Rays, an LDCT scan can detect much smaller tumors: the size of a grain of rice. This allows for a quicker diagnosis, as larger tumors are more likely to have spread to other parts of the body.

When you get an LDCT, you will be asked to lie on a table moved through a donut-shaped device. Beyond that, you’ll need to lie still for a few moments, and you may be asked to hold your breath. You may also be asked to wear a hospital gown and remove jewelry. 

Under Medicare, an LDCT scan is available at no cost for those who qualify. If you are at risk for lung cancer, you’ll also be advised on how to quit smoking (if you’re still an active smoker) or provide support on how to avoid falling back into the habit. If you have Medicare Part D, you can also receive coverage for prescription medications. Medicare Advantage may also cover additional counseling sessions and over-the-counter medications. Are you looking to quit smoking? Are you wondering what other preventive services you can get at no cost through Medicare? Our licensed insurance agents can help. Give us a call at (800) 950-0608 or enter your zip code above to begin your search today.