Medicare Part B covers one annual lung cancer screening via a low dose CT scan. But you must qualify based on recently expanded criteria.
Your lung cancer screening may be covered by Medicare Part B, which is part of Original Medicare and covers outpatient treatments and testing. Here’s what you need to know to determine whether you qualify.
If you have Original Medicare (parts A and B), you can get coverage for one annual lung cancer screening via a low dose computed tomography (CT) scan.
If you have Medicare Advantage (Part C), you should also be able to get a screening. This is because Part C must provide the same coverage as Original Medicare.
In 2022, the Centers for Medicare and Medicaid Services (CMS) expanded its coverage criteria for lung cancer screenings. Under the new criteria, you must:
- be 50 to 77 years old
- have no signs or symptoms of lung cancer
- smoke now or have quit within the last 15 years
- have been smoking for at least 20 years at an average of a pack (20 cigarettes) per day
- get a CT scan request from your doctor or other healthcare professional
These new guidelines lower the criteria for coverage from the previous requirement of 30 packs per day. This is more in line with the U.S. Preventive Services Task Force (USPSTF) guidelines.
Learn more about cancer screening and Medicare.
Lung cancer screenings fall under Medicare Part B. This means that in addition to your monthly premium of $174.70, you’ll have to meet a deductible of $240 before Medicare coverage kicks in.
Generally, the out-of-pocket cost of a lung cancer screening is around $300. If you’ve already met the deductible by the time you do the scan, Medicare will pay 80% of the cost.
You can get screened for lung cancer at a qualifying location.
These testing sites must use low dose CT scans at the appropriate level and follow a standard way of examining and interpreting your lung nodules, as determined by the American College of Radiology (ACR).
You can research screening sites on the ACR website.
Lung cancer is currently the third most commonly diagnosed cancer in the United States, and it most commonly shows up after the age of 65, according to data from the
The average 5-year relative survival rate from 2014 to 2020 was 26.7%, per the NCI data. And the rate at which people died from lunch cancer decreased by about 4.1% each year between 2013 and 2022. These trends may continue to improve as research uncovers additional screening measures or treatments.
The NCI data show that the earlier lung cancer is diagnosed, the higher the survival rate. For this reason, if you meet Medicare’s coverage criteria, it’s important to get screened for lung cancer annually.
That said, getting screened does come with a few risks. These include low level radiation exposure and the possibility of a false positive result.
But these risks are minimal. And since the scan isn’t limited to your lungs, it may potentially detect other health concerns that might otherwise be missed.
Learn more about screening and early detection of lung cancer.
Besides screening, Medicare also provides coverage for cancer treatment, including lung cancer. The treatments must be ordered by a doctor who accepts Medicare. Similarly to screening coverage, Medicare will pay 80% of the cost once you’ve met your deductible.
Specifically, Part A covers hospital care, Part B covers outpatient treatments like chemotherapy or radiation, and Part D will pay for prescription drugs.
Part C (Medicare Advantage) should provide the same coverage as Parts A and B. Some plans will also offer prescription drug coverage. If you need it, you can purchase a Medigap policy that will help you pay for any remaining out-of-pocket costs.
Learn more: Does Medicare cover cancer treatment?
Medicare Part B covers one annual lung cancer screening via a low dose CT scan.
In 2022, CMS expanded its coverage to include individuals ages 50 to 77 years who currently smoke or have quit within the last 15 years or those who have smoked an average of 1 pack per day for at least 20 years.
These new guidelines more closely align with USPSTF recommendations. If you fall under this criteria, Medicare will pay 80% of the cost after you’ve met your Part B deductible.