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Screening for lung cancer with CT scans for those at high risk has now been approved and recommended by an independent government panel, the United States Preventive Services Task Force (USPSTF). Even with this recommendation, lung cancer screening will not be automatically covered as an "Essential Health Benefit" without cost share. This requirement only applies to plans purchased through the newly established health care exchanges. Exchange plans are not required to cover newly endorsed screening until January 2015. However, some plans may voluntarily cover sooner.
Indeed, many "grandfathered" private large group plans have already deemed lung cancer screening "medically necessary." The designation of a procedure as "medically necessary" must be considered merely a guideline. And such a designation does not mean automatic coverage of lung cancer screening. And there could also be a cost share. Whether your specific health plan covers lung cancer screening depends upon the negotiated plan agreement. Of course, you can let your administrator know that you would like lung cancer screening covered in the future!
Finally, at this point, lung cancer screening is not covered by Medicare or Medicaid. Lung Cancer Alliance has been in close contact with the Centers for Medicare and Medicaid (CMS) regarding coverage and has submitted a formal request for a National Coverage Determination for lung cancer screening. Now that USPSTF has issued its final favorable recommendations, CMS can begin the formal NCD process can begin at any moment. Through that process, CMS determines whether a new preventive service like screening is "necessary" or "appropriate" for the Medicare population. If all goes well, CMS can complete its coverage determination within six months.
We will be working continuously on ensuring that lung cancer screening is covered by all relevant entities so please look for periodic updates of this site.
Here is the most current information on major health plans and their coverage of lung cancer screening.
If you have additional questions about coverage, please contact us at firstname.lastname@example.org or 1-800-298-2436.