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Maximizing Medicare: Lung Cancer Screening Benefits

"Medicare Lung Cancer Screening: What Medicare Benefits Are There for Patients with Lung Issues?" text over image of doctor looking at lung x-rays

Just the Essentials…

  • Medicare covers lung cancer screenings for current and recent smokers, as well as hospital stays and treatment.

  • Medicare covers pulmonary rehabilitation for people with COPD or complications from COVID-19.

  • Medicare Advantage can lead to reduced copayments and deductibles.

Breathe Easier With Medicare

The lungs are one of our most important, and most vulnerable organs. Between tobacco smoke, pollution, respiratory disease, and even common workplace and household chemicals, lung issues are distressingly common. Luckily, Medicare covers a variety of services aimed to identify and screen for lung cancer, COPD, or similar conditions.

Lung Cancer Screenings Under Medicare

Original Medicare covers a yearly lung cancer screening, sometimes referred to as a smoker screening, under certain circumstances. Namely, you must:

  • Be between the ages of 55-77
  • Have no current symptoms of lung cancer
  • Be a current smoker, or a former smoker who has quit within the past 15 years
  • Have smoked at least 1 pack of cigarettes a day for a period of at least 20 years
  • Have a referral from a doctor

If you are diagnosed with lung cancer, Original Medicare will cover medically necessary procedures. The specific things that are covered depend on which parts of Medicare you have access to.

Medicare Part A: Hospital Insurance

Medicare Part A covers any inpatient services, as well as services like home healthcare, rehabilitation facilities, skilled nursing care, and hospice care. It will also cover certain clinical studies related to your condition, though this isn’t a guarantee. These services come with a deductible and a limited number of hospital days per year.

Medicare Part B: Medical Insurance

Medicare Part B covers inpatient services and durable medical equipment. This includes doctors visits, radiation therapy, chemotherapy, mental health services, and devices like feeding pumps. Medicare Part B will also cover a lung cancer test if you do not meet the aforementioned criteria. Typically, you will be expected to pay 20 percent of the approved cost after meeting your deductible.

Medicare Part C: Medicare Advantage

Medicare Advantage, which refers to privately offered Medicare plans, offer all of the above benefits by default. They may also cover prescription drugs, as well as in-home aids, transportation, meal delivery, and other non-medical services. You might also have lower or no deductible, lower co-insurance, and an extended number of hospitalization days.

Medicare Part D: Prescription Drug Coverage

Drugs prescribed to help manage your condition are covered under Medicare Part D, a privately offered insurance plan that may be added on to Original Medicare.

Medicare COPD Treatment

Another common lung condition is Chronic Obstructive Pulmonary Disease (COPD), a condition that includes bronchitis (increased mucus and inflammation in the lungs and windpipe) and emphysema (the destruction and enlargement of air sacs in the lungs). Your ability to take in and process air is severely hindered, posing a serious threat to long-term health. 

COPD is commonly found in smokers, though people exposed to cooking or industrial fumes in poorly ventilated spaces may also develop the condition. This condition is screened for with a pulmonary function test (PFT) in which you’ll be asked to breathe into a tube for a short period of time. PFTs are not typically covered by Original Medicare unless you have a history of smoking, but may be covered by certain Medicare Advantage plans.

Should you be diagnosed with COPD, Medicare Part B will cover a comprehensive pulmonary rehabilitation program, as well any oxygen equipment you might need. These services are also available to seniors who have respiratory dysfunction linked to COVID-19. Like with lung cancer treatment, there is a 20 percent copayment for these services, though a Medicare Advantage plan may help reduce the overall costs.

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