Need lung cancer screening? Medicare will pay for some beneficiaries
February 17, 2015 | by Nicole White
Providing lung cancer treatments to patients when their cancer is at its earliest and most treatable stages will now be a more attainable goal: Medicare has agreed to cover lung cancer screening for those beneficiaries who meet the requirements.
The only proven way to detect lung cancer early enough to save lives is through low-dose computed tomography (CT) screening. One of the largest randomized, controlled clinical trials in the National Cancer Institute’s history showed that this screening could reduce lung cancer mortality rates by at least 20 percent. This is a significant reduction; lung cancer currently has a five-year survival rate of 17 percent. For people diagnosed at advanced stages, survival rates are less than 4 percent.
"Finally, seniors who are at high risk for lung cancer can undergo screening without the barrier of out-of-pocket costs,” said Dan Raz, M.D., co-director of the Lung Cancer and Thoracic Oncology Program at City of Hope. “Medicare got this right because lung cancer screening saves lives in high-risk current and former smokers. In fact, the low-dose CT scan to screen for lung cancer has the potential to save more lives than any cancer test in history.”
Lung cancer is the leading cause of cancer death in the United States, killing nearly 160,000 people each year. Almost 90 percent of people who develop lung cancer die from the disease, in part because it’s often not detected until it has already advanced and spread.
The February ruling by the Centers for Medicare and Medicaid Services finalizes a draft decision issued in November 2014 that brings the benefit of screening to approximately 5 million American seniors, the most at-risk group for lung cancer. This represents close to half of the entire at-risk public who would qualify for screening.
The coverage is effective immediately. Medicare will pay for an annual lung cancer screening test for those who are 55 to 77 years old and who are current smokers or who quit in the last 15 years. To qualify, they must also have a 30 pack-year history of smoking – an average of a pack a day for 30 years – and a written order from a physician. The benefits extend to seniors up to age 77, though the U.S. Preventive Services Task Force guidelines call for screening to be available until age 80.
Medicare will also cover a visit to a physician for lung cancer screening counseling. Advocates for lung cancer screening have suggested patients seek out centers of excellent for screening, which are identified by the Lung Cancer Alliance – and include City of Hope. These centers have expertise in reading results, which helps reduce the number of false-positive results and unnecessary biopsies.
Learn more about becoming a patient or getting a second opinion at City of Hope by visiting our website or by calling 800-826-HOPE (4673). City of Hope staff will explain what's required for a consult at City of Hope and help you determine, before you come in, whether or not your insurance will pay for the appointment.