Medicare may soon begin paying for yearly scans to detect lung cancer in certain current or former heavy smokers.
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The Centers for Medicare and Medicaid Services on Monday issued a long-awaited proposal to begin covering the screening for high-risk beneficiaries if their doctors agree they meet the criteria.
Lung cancer kills nearly 160,000 Americans a year, in part because tumors aren't usually detected early enough for treatment to stand a good chance. A major study found low-dose CT scans of the lungs of people at especially high risk could cut their chances of dying from lung cancer by 20 percent.
Last December, the U.S. Preventive Services Task Force recommended the test for certain people ages 55 to 80 who smoked a pack of cigarettes a day for 30 years, or the equivalent. Under the Affordable Care Act, that meant private insurers had to begin covering the screening.
But the health care law doesn't require Medicare to pay for the scans, which can cost $100 to $400. CMS had to decide the issue separately, and its advisers questioned if the test really would benefit seniors. Only a quarter of participants in that lung screening study were 65 or older, and no one over 76 was screened.
Among the issues was whether the test would catch too many seniors with multiple health problems who couldn't withstand cancer treatment. Plus, screening tests can cause false alarms that require invasive follow-up tests to rule out cancer.
Monday, CMS proposed covering the test for certain high-risk Medicare recipients, but capped the age for testing at 74. It said the decision "strikes an appropriate balance" between access to the screening and ensuring that benefits outweigh the harms.
To be eligible, Medicare patients would be current smokers or have quit within the last 15 years, and have that 30-pack-year smoking history, verified by a health provider's written order for the test. Before the first CT scan, they would have to receive counseling about the pros and cons of screening — and about the importance of quitting smoking.
"Tens of thousands of lives will be saved by providing America's seniors with fair and equitable access to the same lifesaving lung cancer screening that is now being offered to those with private insurance," said Laurie Fenton Ambrose of the Lung Cancer Alliance, which had requested Medicare's decision.
The alliance estimated 4 million Medicare recipients would be eligible for screening.
Medicare's proposal is open for public comment for 30 days; a final decision is due in February.