Detecting lung cancer early is critical to getting the best treatment outcomes. Unfortunately, it’s not always clear if health insurance will cover the cost of these tests. If you’re unsure whether your carrier will help pick up the tab, you may hesitate to have potentially life-saving screenings.

Insurance coverage can vary widely depending on your plan. Most insurance covers lung cancer screening if your doctor recommends it. However, you may have to pay for a portion of the cost, and additional follow-up tests may or may not be covered. With a little detective work, you can find out what screenings make the most sense for you and how to afford them.

Should I Get Screened?

Screening for lung cancer is done using low-dose computed tomography (LDCT). During an LDCT scan, a technician uses a quick and painless chest X-ray to produce images of your lungs to see if they contain any abnormal growths.

According to the U.S. Preventive Services Task Force, adults between the ages of 50 and 80 who have a 20-pack-year smoking history should get lung cancer screening tests every year — as long as they currently smoke or quit within the past 15 years. A “pack-year” means smoking one pack of cigarettes per day for one year.

Reasons Not To Get Screened

Although lung cancer screening is beneficial for some people, more screening isn’t always better. Screenings can sometimes result in false positives, meaning they may mistakenly identify harmless spots or growths as cancer. A false positive can lead to unnecessary follow-up tests and surgeries.

A lung cancer screening test can also result in overdiagnosis. This means the test could find cancer that may never have caused any problems, again leading to unnecessary treatment.

If you have a family history of lung cancer or think you have a high risk despite not meeting the usual criteria, talk to your health care provider. They can discuss with you the pros and cons of getting checked.

In addition, it’s important to be in relatively good health before screening. If you’re unwilling or unable to undergo lung cancer treatment if needed, you may not benefit from being screened.

A person generally shouldn’t get screened for lung cancer if they:

• Are over 80 years old
• Haven’t smoked in more than 15 years
• Have another health problem that would prevent them from getting lung cancer treatment

Government Plans vs. Private Insurance

Navigating insurance coverage for lung cancer screenings can be complicated and overwhelming. You can call to speak with a representative from your insurance carrier who can answer any specific coverage questions. Your costs may vary depending on whether you have Medicare, a state-sponsored plan, or coverage through a private company.

Medicare

If you have Medicare, you can go to Medicare.gov or call 1-800-MEDICARE (1-800-633-4227) for information about your coverage for health screenings. Lung cancer screenings are covered under Medicare Part B for people who don’t have symptoms and meet all of the following criteria:

• You are between the ages of 50 and 77 (or possibly older if you have a Medicare Advantage Plan).
• You currently smoke or quit within the past 15 years.
• You have a smoking history of 20 pack-years

You’ll also need an order from your health care provider verifying that they think you should be screened. Once the screening request is approved, Medicare pays the provider directly. You shouldn’t have to pay anything as long as the provider and the facility are in-network. It’s always a good idea to double-check when making your appointment.

Medicaid

Medicaid coverage for lung cancer screening varies depending on where you live. Some states may follow Medicare guidelines for coverage eligibility, while others may have their own criteria. Ask about the eligibility requirements for lung cancer screening and any potential fees by contacting your Medicaid provider.

Private Insurance

People with private insurance plans, such as insurance provided by an employer, should speak with a representative to learn more about their coverage. While the eligibility standards for lung cancer screening may be the same as with government plans, there could be differences.

Once you find out the eligibility criteria, ask if there’s a specific facility or doctor you need to go to for the screening. Familiarize yourself with other details, like your deductible and copay, to understand what to expect before you schedule the screening. You should always ask for coverage details in writing so you can refer back if you end up with an unexpected medical bill.

How To Get the Answers You Need

Asking the right questions will help you determine whether your insurance company covers lung cancer screenings. Check the back of your insurance card to find the right phone number to call. You’ll also want to keep this card handy to provide the operator with your plan or identification number.

Here are some questions you can ask:

• What are my insurance plan’s specific eligibility criteria for lung cancer screening coverage?
• Do I need a referral or preauthorization to get screened?
• What paperwork should I complete to get the screening covered by insurance?
• Are there any out-of-pocket costs associated with lung cancer screening, such as copayments, deductibles, or coinsurance?
• Are there any limitations on how often my lung cancer screenings are covered?
• Do I have to get screened at a specific facility? If so, what if it’s too far away?
• Does my plan cover additional tests or procedures that may be recommended after a lung cancer screening, such as diagnostic imaging or biopsy?

It’s essential to understand your insurance coverage to get the most value from your health care plan. If you find out that your plan won’t cover the cost of screening, but you still feel it’s needed, you can also ask the medical facility about the cost of paying out-of-pocket without coverage. You may be able to get a discounted screening as part of a promotional program or at a health fair.

Talk With Others Who Understand

MyLungCancerTeam is the social network for people with lung cancer and their loved ones. On MyLungCancerTeam, more than 12,000 members come together to ask questions, give advice, and share their experiences with others who understand life with lung cancer.

Do you have tips for getting insurance to cover lung cancer screening? Share your story in the comments below, or start a conversation by posting on your Activities page.