The U.S. Preventive Services Task Force recently updated its lung cancer screening recommendations, making more patients eligible sooner. The catch: insurance companies have until 2023 to adapt their coverage.
What are the new recommendations for lung cancer screening?
The USPSTF now recommends yearly low-dose computed tomography (CT) scans for people aged 50 to 80 years old. This is a shift from the previous guidelines, which recommended starting screening at 55. Another significant change: the number of pack-years that make a person eligible for screening. New guidelines drop the baseline from 30 pack-years to 20. (A pack-year is the equivalent of smoking an average of one pack of cigarettes each day for a year.)
Will screening be covered by insurance?
The short answer is “not necessarily,” says Aimee Strong, DNP, program coordinator for UVA’s Lung Cancer Screening Program. Commercial payers may voluntarily opt to cover the screening for this expanded population, but they aren’t required to do so until the deadline.
Under the Affordable Care Act, private payers and Medicaid expansion plans will also be required to adapt their coverage. Medicare, however, does not. The American College of Radiology, the American Thoracic Society and others have written letters to CMS asking them to consider adopting the new USPSTF guidelines and to re-open the National Coverage Determination. This review will take time, however.
On a positive note, some insurance providers are getting a jumpstart on coverage. “Insurance companies may, in fact, move quicker to update their coverage policies,” says Strong. “Anthem and Medicaid Medallion, for example, have already adopted the new guidelines.”
How should patients who want to be screened navigate the insurance coverage issue?
“We are recommending that anyone aged 50 to 54 with a 20-pack-year history to call their insurance company to ensure they are covered under the new guidelines before scheduling a screening,” says Strong. Note that, even if the screening is covered, patients may be responsible for a co-pay or their deductible may be applied until the full coverage requirement goes into effect.
Learn how to refer your eligible patients for lung cancer screening.