If you smoked for years, Medicare will pay for a yearly scan that can catch lung cancer while it’s still small. If your provider accepts Medicare assignment, the scan costs nothing.
And most people who qualify for screening aren’t getting it.
In 2024, only 24.5% of adults who met the federal screening guidelines were current on their scans, according to a study from the University of Kentucky’s Markey Cancer Center published in JAMA Internal Medicine.
That’s roughly 1 in 4. The rate was up from 2022. But Todd Burus, an assistant professor in the UK College of Medicine and one of the researchers, said, “We still have a long way to go.”
That’s a problem, because lung cancer kills more Americans than any other cancer, according to the Centers for Disease Control and Prevention.
I don’t blame the 3 in 4. The rules are fussy, the math is confusing, and Medicare makes you jump through a hoop before the first scan. Here’s how to get through all of it.
1. Find out if you qualify
Medicare Part B covers one low-dose CT lung scan a year if you meet every one of these conditions, according to Medicare.gov:
- You’re 50 to 77 years old.
- You have no signs or symptoms of lung cancer.
- You smoke now, or you quit no more than 15 years ago.
- You have a smoking history of at least 20 “pack-years” (more on that below).
- Your doctor or another provider orders the scan.
One wrinkle: Medicare and the experts don’t line up perfectly. The U.S. Preventive Services Task Force recommends yearly screening for people 50 to 80 with the same smoking history. Medicare’s coverage rule stops at 77.
So if you’re 78 to 80, the task force says screening fits you, but Medicare’s screening benefit doesn’t. Ask your doctor about that gap before you book anything.
Notice that symptoms rule, too. This is a screening for people who feel fine. If you’ve got a cough that won’t quit or other worrying signs, that’s a conversation with your doctor, not a screening appointment.
2. Do the pack-year math
This is where people trip. A pack-year isn’t a year you smoked. It’s a pack a day for a year, with a pack counted as 20 cigarettes, according to Medicare’s coverage rules.
The formula: packs per day times years smoked. You need 20 or more.
Here’s how it plays out:
- A pack a day for 20 years: 1 x 20 = 20 pack-years. You qualify.
- Half a pack a day for 40 years: 0.5 x 40 = 20 pack-years. You qualify.
- Two packs a day for 10 years: 2 x 10 = 20 pack-years. You qualify.
- A pack and a half a day for 15 years: 1.5 x 15 = 22.5 pack-years. You qualify.
- Half a pack a day for 30 years: 0.5 x 30 = 15 pack-years. You fall short.
If you checked years ago and missed the cut, check again. Medicare used to require 30 pack-years. It dropped the bar to 20 in 2022, according to a Centers for Medicare and Medicaid Services notice to providers.
Then check the clock. The coverage depends on your quit date, not just your total. If you quit at 60, you’ve got until about 75 before you age out of the 15-year window.
3. Book the talk before the scan
Here’s the hoop. Before your first lung scan, Medicare requires a separate visit with your provider to weigh the pros and cons and figure out whether screening makes sense for you.
Under Medicare’s national coverage rules, that visit has to include a shared decision-making discussion using at least one decision aid, plus counseling on sticking with yearly scans. Current smokers also get information about help quitting. Former smokers get a nudge to stay quit.
This is the step where a lot of people stall. The scan can’t happen until the conversation happens.
So call your doctor and ask for it by name: a lung cancer screening counseling and shared decision-making visit. Then ask for the order for the scan at the same time.
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4. Know what you’ll pay
For the screening itself, your cost is $0 as long as your provider accepts Medicare assignment, according to Medicare.gov.
So ask that question before you book: “Do you accept Medicare assignment?” It takes 10 seconds and can be the difference between a free scan and a bill.
Also ask what happens if the scan finds something. Follow-up tests are a separate matter, so ask your provider what Medicare will cover before you agree to extras.
5. Expect a false alarm — and don’t panic
Low-dose CT scans are sensitive. They spot lots of small things in the lungs, and most of them aren’t cancer.
In the National Lung Screening Trial — the big federal study, published in 2011, that showed these scans work — 96.4% of positive results from the low-dose CT turned out to be false alarms, according to the National Cancer Institute.
The task force says roughly 26% of first-round scans in that trial were false positives. And it lists false positives, with the extra tests and procedures that can follow, as a harm of screening.
The good news, per the NCI: In that trial, the follow-up was usually just more imaging; few people needed anything invasive. When biopsies do happen, possible complications include a partially collapsed lung, bleeding and infection.
That’s why the counseling visit matters. You should go in knowing a callback is common.
Screening isn’t for everybody forever, either. The task force says to stop once you’ve gone 15 years without smoking, or if a health problem substantially limits your life expectancy.
Not every test is worth taking at every age, as we noted in “7 Medical Tests and Treatments You Might Be Smart to Skip After 65.”
6. Never smoked? Test your house for radon
None of this screening coverage applies if you never smoked. But that doesn’t mean your lungs are off the hook.
Radon gas is the top cause of lung cancer in people who don’t smoke, according to the Environmental Protection Agency. It’s No. 2 overall, behind smoking.
The EPA ties about 21,000 lung cancer deaths a year to radon. Roughly 2,900 of those are people who never smoked.
The fix starts with a test. The EPA says to fix your home if the level is 4 picocuries per liter or higher.
Bottom line
In that federal trial, people screened with low-dose CT had about 15% to 20% fewer lung cancer deaths than people screened with chest X-rays, according to the NCI. Medicare will cover the scan for free if you qualify and use a provider who accepts assignment.
Here’s what I’d do this week: Run your pack-year math. If you hit 20 and you’re within the age and quit-date limits, call your doctor, ask for the counseling visit, and get the order.
Lung cancer screening is just one of the free Medicare screenings that could save your life. You’re paying Medicare premiums anyway. Use what they buy.
And as always, this isn’t medical advice. Talk with your doctor about whether screening is right for you.
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