Lung cancer screening coverage was expanded in the private market even before it was decided last week that Medicare would cover it for more patients.
The Centers for Medicare & Medicaid Services announced Thursday the national coverage determination, expanding coverage of low-dose computed tomography for Medicare patients in line with current recommendations, such as those from the U.S. Services Task Force. preventive.
The decision expands eligibility for people with Medicare to receive LCDT lung cancer screening starting at age 50 (instead of 55). Regardless, Medicare now covers screening tests for people whose smoking history includes the use of 20 packs per year. Previously, LCDT was only covered by Medicare for those who smoked 30 packs a year. While most Medicare beneficiaries are age 65 or older, younger people with chronic conditions like kidney failure are also covered by state insurance.
Medicare's announcement shows the agency is catching up with coverage already offered by private insurers.
"The UnitedHealthcare commercial has already implemented (coverage) in accordance with USPSTF guidelines," Heather Soule, a spokeswoman for the nation's largest insurer, said in an email.
Ethan Slavin, a spokesman for Etna, echoed this.
"Our clinical policy bulletin for business members is based on USPSTF guidelines," he said in an email. The lung cancer screening guideline posted online states that "Aetna may perform an annual low-dose computed tomography (LDCT), also known as a spiral CT or spiral CT, as medically necessary to current or former smokers aged 50 to 80. A pack is considered to have a 20-year or more history of smoking and, if a former smoker, has quit within the last 15 years.”
Anthem, Cigna and Humana and the industry trade group AHIP did not respond to requests for more information about commercial lung cancer screening coverage on Friday.
LCDT is a special type of CT scan that uses computers to create high-quality images of the lungs to detect abnormal areas that may be non-small cell lung cancer. It is the only recommended screening test for lung cancer, one of the leading causes of cancer death.
In addition to binding Medicare Advantage plans from private insurers, CMS coverage decisions often influence coverage patterns in the private market. However, in some cases, such as LDCT lung cancer screening, private insurers offer stronger coverage or cover services not covered by Medicare.