For the first time ever, starting Jan. 1, individuals who are at high risk for developing lung cancer may be eligible for screening at no out-of-pocket cost.
Most people with private insurance, individuals who are enrolled in their state health insurance marketplaces and people enrolled in state Medicaid expansion will be eligible for early detection screening without cost to them.
Patients considered to be high risk and potentially eligible for screening are age 55 through 80; have a 30 pack-year history of smoking (this means one pack a day for 30 years, two packs a day for 15 years, etc.); and are a current smoker, or have quit within the last 15 years. Screening people at high risk has the potential to save more than 13,000 lives a year.
In December 2013, the U.S. Preventive Services Task Force (USPSTF) awarded a “B” grade to annual low-dose CT screening for individuals at high risk for lung cancer. Under the Affordable Care Act, effective prevention measures — graded A or B 4— are included in the Essential Health Benefit. Individuals enrolled in state health marketplace plans, enrolled in Medicaid-expansion programs and those with non-grandfathered private insurance plans who meet the screening criteria will have insurance coverage for screening without co-payments or other barriers starting Jan. 1 or the beginning of their next plan year. The American Lung Association has created a chart to help explain this coverage. The Lung Association also created a checklist for individuals to use when calling their insurance companies to determine if they are eligible for screening with no cost.
The American Lung Association also provides many free resources for lung cancer patients and their caregivers. Patients can determine if they are candidates for lung cancer screening through www.LungCancerScreeningSavesLives.org.
Additional resources include Facing Lung Cancer: Support from Day One, a comprehensive online resource with interactive features that offers education and support to people living with lung cancer and their loved ones. The Lung Connection is an online community where individuals living with lung disease and their caregivers can discuss how lung disease affects their lives and share experiences with peers.
Medicare, which provides health care insurance for most Americans over the age of 65, is in the midst of a separate National Coverage Determination process to determine coverage for lung cancer screening among its beneficiaries. In November, the Centers for Medicare and Medicaid Services proposed to offer an annual low-dose CT scan for Medicare beneficiaries at high risk. A final coverage announcement from CMS is expected for Medicare patients in February.
Lung cancer is the leading cause of cancer death for both men and women in the United States. The five-year survival rate for lung cancer patients is only 17.8 percent. An annual low-dose screening test for individuals at high risk has the potential to dramatically improve lung cancer survival rates by finding the disease at an earlier, more treatable stage. The USPSTF estimates that if everyone who is at high risk is screened, there will be a 14 percent reduction in lung cancer deaths in the United States.
Information on screening and other lung cancer risk factors including exposure to secondhand smoke, radon, air pollution and other hazardous materials, can be found on the American Lung Association’s website.