Expanded Lung Cancer Screening under Medicare: Details and Beyond
Lung cancer is a serious health concern, particularly for those who have a history of smoking. However, early detection can significantly improve the outlook, and Medicare offers coverage for lung cancer screenings and treatments.
Eligibility for Lung Cancer Screening
To be eligible for a yearly lung cancer screening, a person must be between 55-77 years of age, not have signs or symptoms of lung cancer, be a current smoker or have quit within 15 years, have smoked an average of one pack (20 cigarettes) per day for 30 years, and have an order from a doctor. The screening test is known as a low dose computed tomography (LDCT) scan, which is covered by Medicare Part B with no charge for eligible members.
Customized Treatment
If the LDCT scan result is positive, a doctor may recommend more tests and ask for an annual LDCT screening test. Treatment is then customized to the person since no two lung cancers are the same. Some treatments available for lung cancer include surgery, chemotherapy, radiation, targeted therapy, immunotherapy, clinical trials, complementary medicine, and alternative medicine.
Medicare Coverage for Lung Cancer Treatment
Medicare Part A covers inpatient hospital care (including inpatient radiation therapy). Patients typically pay a deductible for hospital stays and may have coinsurance for extended stays. Medicare Part B covers outpatient services such as outpatient radiation therapy, doctor visits, and medical equipment. The patient must pay an annual deductible (around $257 in 2025) and then typically 20% coinsurance of the Medicare-approved amount for services.
Medicare Part C (Medicare Advantage) plans combine Parts A and B and often include extra benefits. These plans may have lower out-of-pocket costs than Original Medicare but vary by plan. They cover hospital, outpatient, and sometimes prescription drugs. Medicare Part D covers outpatient prescription drugs, including oral chemotherapy and other cancer medications taken at home.
Out-of-Pocket Costs
Out-of-pocket costs for lung cancer treatment under Medicare (including Parts A, B, C, and D) can range roughly from $4,361 to over $10,000 annually, depending on the chosen plan and treatments needed. Supplement plans like Medigap Plan G can reduce out-of-pocket expenses significantly, leaving a patient responsible for only the Part B deductible (around $257).
Biomarkers and Clinical Trials
Under a microscope, a doctor will look for biomarkers and may find more information that can help build a treatment plan. Medicare covers some costs and services in specific clinical trials relating to cancer.
Coordinated Care and Support Services
Medicare works with healthcare practices to provide coordinated care through the Enhancing Oncology Model, offering a personalized care plan, 24/7 health professional availability, help coordinating care with healthcare professionals and community organizations, and financial, emotional, and social support services.
Resources for Guidance
The American Lung Association offers many helpful resources, including information on financial assistance programs and local support groups. Medicare offers resources to help guide individuals through the complex world of medical insurance.
In summary, early detection of lung cancer through annual LDCT screenings can lead to effective treatment under Medicare. It's crucial for eligible individuals to take advantage of this service and to understand the costs and coverage associated with their chosen plan.
- For those who qualify, Medicare Part B covers the yearly low dose computed tomography (LDCT) scan for lung cancer screening with no charge for eligible members.
- Treatment options for nonsmall cell lung cancer may involve surgery, chemotherapy, radiation, targeted therapy, immunotherapy, clinical trials, complementary medicine, and alternative medicine.
- Medicare Part A covers inpatient hospital care, including inpatient radiation therapy, and patients may have to pay a deductible and coinsurance for extended stays.
- Out-of-pocket costs for lung cancer treatment under Medicare can be reduced significantly by Medigap Plan G, leaving patients responsible only for the Part B deductible.
- Medicare works with healthcare practices to provide coordinated care through the Enhancing Oncology Model, offering emotional, financial, and social support services, in addition to customized care and 24/7 health professional availability.
