New Act Mandates Free Annual Lung Cancer Screening for At-Risk Adults 50-80, Bans Prior Authorization

The Lung Cancer Screening Expansion Act of 2025 is straightforward: it mandates that virtually all health insurance plans—from your employer’s group plan to individual coverage and federal programs like TRICARE and the VA—must cover annual lung cancer screenings for eligible individuals. The kicker? They have to cover it fully, meaning zero dollars out-of-pocket for you. No copay, no deductible, no surprise bill.

This isn't just about covering the cost; it's about eliminating the administrative headache. The bill explicitly bans insurers from requiring prior authorization or step-therapy for this screening. If you’ve ever had to wait weeks for your doctor to fight with your insurance company just to get a necessary test approved, you know what a huge win this is for getting timely care. The goal is simple: if you meet the criteria, you get the screening without bureaucratic delays.

Who Gets the Free Screening?

This coverage isn't for everyone; it targets a specific population determined to be at higher risk. To be eligible, you must be an adult who meets two criteria laid out in Section 3:

1. You must be between 50 and 80 years old.
2. A treating healthcare professional must determine that you are at increased risk for lung cancer based on personal, environmental, or familial factors.

This is where the policy gets a little squishy—and necessarily so. The bill doesn't define 'increased risk' with specific numbers (like pack-years of smoking), but leaves that judgment to your doctor. For someone who quit smoking years ago but worked in a high-exposure environmental job, or someone with a strong family history of the disease, this provision opens the door to life-saving early detection without the financial stress.

The Cost of Convenience: Who Pays?

Whenever a law mandates free coverage, someone is footing the bill. In this case, it’s the insurance companies and the federal health programs. For private insurers and group plans, this means absorbing the cost of a new, required preventative service (SEC. 2). While this is great news for patients, it does place a new financial burden on the system, which could eventually factor into premium costs.

For federal programs like the VA and Defense Department, the bill requires the relevant Secretaries to issue regulations and comply within a tight 180-day deadline (SEC. 4). Six months is a fast turnaround for four major federal agencies to coordinate, write rules, and implement a massive new coverage mandate. This tight timeline shows the urgency behind the bill, but it could present some logistical hurdles for the agencies tasked with rolling it out smoothly.

The Real-World Impact

Ultimately, this bill is a huge step toward making preventative care accessible, which is critical for a disease like lung cancer where early detection radically improves survival rates. For the 55-year-old construction worker or the 62-year-old office manager who qualifies, this means one less barrier to getting checked out. They don't have to worry about a $500 deductible or a week-long fight with their insurance company just to get the screening done. The policy cuts out the red tape and the cost, focusing solely on public health benefit. It’s a clear win for patients who fall into that high-risk, mid-life bracket.