Does Medicare Cover Lung Cancer Screening?
Key Takeaways
- Medicare covers annual lung cancer screening.
- Eligibility requires a history of smoking, being a current smoker or having quit within the last 15 years, and having no symptoms.
- A doctor’s order during a screening counseling visit or annual physical is needed for coverage.
- Early lung cancer screening is vital as it improves treatment outcomes and survival rates by detecting cancer at earlier stages.
Does Medicare cover lung cancer screening? The answer is yes, Medicare will cover lung cancer screening when specific criteria are met. Low-Dose Computed Tomography (LDCT) is the only test covered for lung cancer screening. LDCT uses a low level of radiation to take detailed pictures of the lungs.
If you meet the eligibility criteria and have a doctor’s order, Medicare will cover the lung cancer screening at a Medicare-approved facility. Learn more about lung cancer screening criteria for Medicare.
Why Screen for Lung Cancer?
Lung cancer screenings are crucial for detecting lung cancer at an early stage. Unfortunately, 43% of lung cancer cases are not caught until a late stage when survival rates are less than 10%. The earlier it is detected, the more likely it can be treated.
Lung cancer screenings are recommended for people at higher risk of developing lung cancer, such as older adults and those who have a history of smoking. Screening is non-invasive and readily available at most healthcare facilities. Annual screening is recommended and is a covered benefit under Original Medicare Part B if you meet eligibility criteria.
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How Medicare Covers Lung Cancer Screenings
Original Medicare Part B covers lung cancer screening when the following eligibility requirements are met:
- Age: Medicare covers annual lung cancer screening for beneficiaries between the ages of 50 and 77 years.
- Smoking History: Beneficiaries must have a history of smoking one pack per day for 20 years or two packs per day for 10 years, be a current smoker, or have quit smoking within the last 15 years.
- Asymptomatic: You must not have any signs or symptoms of lung cancer, such as coughing up blood, shortness of breath, or chest pain.
- Physician’s Order: The screening must be ordered by a healthcare provider during a lung cancer screening counseling visit or annual physical.
If you meet the eligibility criteria, Medicare covers the screening at a Medicare-approved facility.
How Medicare Advantage Covers Lung Cancer Screenings
Medicare Advantage plans, also known as Medicare Part C, are managed by private insurance companies. These plans replace your federal Part A and Part B coverage. Medicare Advantage plans must cover all the same services that Original Medicare covers, including lung cancer screening.
However, many Medicare Advantage plans offer additional benefits beyond Original Medicare. For example, Medicare Advantage Prescription Drug Plans bundle Part D drug coverage. Benefits differ based on plan, carrier, and location.
How Much Lung Cancer Screenings Costs With Medicare
The costs of lung cancer screening depend on whether you have Original Medicare or a Medicare Advantage plan. If you have Original Medicare, your Part B coverage will help cover the cost of lung cancer screening. The following is the cost breakdown for Medicare Part B:
- Premium: The monthly Part B premium is $185 in 2025.
- Deductible: This is the amount you must pay in covered benefits before your Part B plan begins to share costs. The deductible is $257 in 2025.
- Coinsurance: Coinsurance is the percentage a patient pays after meeting their deductible. Medicare Part B covers 80% of the billed amount. This leaves you to cover the remaining 20%.
Medicare Advantage plans have their own premiums, deductibles, copays, and coinsurance rates. Like Medicare Part B, Medicare Advantage plans cover lung cancer screening as the eligibility criteria are met.
Putting It All Together
Lung cancer screening is essential for detecting lung cancer in the early stages. Lung cancer screenings are a covered benefit under Original Medicare Part B and Medicare Advantage when eligibility criteria are met. Early detection can help increase the chances of successful treatment.
Sources
- Lung Cancer Key Findings. American Lung Association.