A yearly low-dose CT scan can find lung cancer early in people at high risk, and for those who qualify, it’s usually free under insurance. But the rules are specific: your age, how much you smoked and when you quit all matter, and Medicare’s rules differ slightly from private insurance. Here’s how to tell if your screening will be fully covered.
Key takeaways
- Most private health plans must cover yearly low-dose CT lung screening with no cost sharing for adults 50 to 80 who have a 20 pack-year smoking history and currently smoke or quit within the past 15 years.
- Medicare covers it for people 50 to 77 who meet the same smoking criteria, with no cost if your provider accepts assignment.
- Medicare requires a counseling and shared decision-making visit before your first screening.
- If you quit more than 15 years ago, some medical groups still recommend screening, but your insurance may not have to cover it for free.
- Follow-up scans after an abnormal result may come with costs.
Who qualifies: the rules side by side
| Private insurance (USPSTF rule) | Medicare | |
|---|---|---|
| Age | 50 to 80 | 50 to 77 |
| Smoking history | At least 20 pack-years | At least 20 pack-years |
| Current smoking status | Currently smoke, or quit within the past 15 years | Currently smoke, or quit within the past 15 years |
| Symptoms | For people without symptoms | No signs or symptoms of lung cancer |
| Other requirements | Discussion of benefits and harms recommended | Doctor’s order and a counseling visit before the first scan |
| How often | Once a year | Once a year |
| Your cost | $0 in network for most plans | $0 if the provider accepts assignment |
Private insurance rules follow the U.S. Preventive Services Task Force (USPSTF), whose current recommendation was published in March 2021. Under the Affordable Care Act, most private plans must cover USPSTF-recommended screenings without cost sharing.
What is a pack-year?
A pack-year measures how much you’ve smoked over time. One pack-year equals smoking an average of one pack (20 cigarettes) a day for one year.
To calculate yours: packs per day × years smoked = pack-years.
| Example | Pack-years |
|---|---|
| 1 pack a day for 20 years | 20 |
| 2 packs a day for 10 years | 20 |
| Half a pack a day for 30 years | 15 (doesn’t meet the 20 pack-year rule) |
Be as honest and accurate as you can with your doctor. Your eligibility depends on it.
The Medicare counseling visit
Before your first screening, Medicare requires a visit with your provider to talk about the benefits and risks of screening and decide whether it’s right for you. Your provider should also talk with you about quitting smoking if you still smoke.
After that, Medicare covers one screening a year as long as you still qualify.
When you might not get full coverage
You quit more than 15 years ago. In 2023, the American Cancer Society updated its guideline to recommend yearly screening for people 50 to 80 with a 20 pack-year history, no matter how long ago they quit. But insurance coverage is tied to the USPSTF recommendation, which still uses the 15-year rule. If you quit longer ago, ask your insurer whether they’ll cover it.
You’re 78 to 80 and on Medicare. Medicare’s coverage ends at 77, while the USPSTF recommendation goes up to 80.
You have symptoms. If you have a cough that won’t go away, coughing up blood or other symptoms, your doctor may order a diagnostic CT instead. That’s not screening, so normal cost sharing applies.
You use an out-of-network provider or have a grandfathered or non-ACA plan.
You need follow-up. If your screening finds a nodule, your doctor may order a follow-up CT, a PET scan or a biopsy. Depending on your plan, these may be billed as diagnostic and come with copays or coinsurance. Ask your insurer before the follow-up.
Medicaid
Medicaid coverage of lung cancer screening varies by state. Many states cover it, and people covered through Medicaid expansion generally have coverage of USPSTF-recommended preventive services. Check with your state Medicaid program or health plan.
How to get screened without a surprise bill
- Talk to your doctor about whether screening is right for you, and get an order.
- Confirm you meet your insurer’s criteria: age, pack-years and quit date.
- Make sure the imaging center and radiologist are in your network or accept Medicare.
- Ask that the scan be ordered and billed as a lung cancer screening, not a diagnostic CT.
- If you have a nodule and need follow-up, ask your insurer what you’ll pay before scheduling.
Frequently asked questions
How much radiation is in a low-dose CT? Less than a standard chest CT. RadiologyInfo lists about 1.5 mSv for a low-dose lung screening CT, compared with about 6.1 mSv for a regular chest CT. Our CT radiation guide explains what that means.
Does vaping or marijuana count toward pack-years? No. Pack-years are based on cigarette smoking. Talk to your doctor about your full history.
I quit 20 years ago. Can I still get screened? Some guidelines say yes, but your insurer may not cover it for free. Ask your doctor and your insurer.
Is there a cost if I’m on Medicare and meet the criteria? No, as long as your provider accepts assignment. You’ll still need the counseling visit before your first scan.
Sources
- U.S. Preventive Services Task Force: Lung Cancer Screening, final recommendation (March 2021).
- Medicare.gov: Lung cancer screenings.
- American Cancer Society guideline update, reported by STAT News and The ASCO Post (November 2023).
- RadiologyInfo.org (ACR and RSNA): Radiation dose in X-ray and CT exams.
This article is for general information only and isn’t medical advice. Talk with your doctor about whether lung cancer screening is right for you, and check with your insurer about costs.