Lung cancer screening coverage in the private market had been expanding even before last week’s decision to let Medicare cover more patients.
Centers for Medicare and Medicaid Services Nationwide coverage determination announced Thursdaybased on current recommendations to expand coverage of low-dose computed tomography scans for Medicare patients, e.g. Those from the U.S. Preventive Services Task Force.
The decision expands eligibility to allow those with Medicare to receive LCDT lung cancer screening starting at age 55. In addition, Medicare now covers smoking history including screening for those who consume 20 packs per year. Previously, LCDT was only available for people who smoked 30 packs a year. While most Medicare beneficiaries are 65 and older, younger people with chronic conditions such as kidney failure are also covered by government insurers.
Medicare’s announcement shows that the agency is catching up with the coverage that private insurers already offer.
“UnitedHealthcare Commercial has implemented (covering) in accordance with USPSTF guidance,” Heather Soule, a spokeswoman for the largest US insurance company, said in an email.
Aetna spokesman Ethan Slavin agrees.
“Our clinical policy announcement for commercial members is based on USPSTF guidelines,” he said in an email. Publish onlineThe Lung Cancer Screening Policy states, “Aetna considers annual low-dose computed tomography (LDCT) scans, also known as helical CT or helical CT scans, a pack of 20 per year in medicine for current or former smokers 50 to 80 years of age. A smoking history of one year or more, and if ever smoking, quit smoking within the past 15 years.”
Anthem, Cigna and Humana and industry trade group AHIP did not respond to requests for comment on Friday for more information on commercial insurance for lung cancer screening.
LCDT is a special type of CT scan screening that uses a computer to generate high-quality images of the lungs to detect abnormal areas that may be non-small cell lung cancer. This is the only recommended screening for lung cancer, the leading cancer killer.
In addition to being binding on Medicare Advantage plans offered by private insurers, CMS’ underwriting decisions often affect coverage models in the private market. However, in some cases—such as LDCT screening for lung cancer—private insurers offer stronger coverage or cover services not already covered by Medicare.
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