This Act expands access to lung cancer screening without cost-sharing or prior authorization in Medicaid and Medicare, broadens tobacco cessation coverage in Medicaid, and mandates similar protections in private insurance, alongside funding education and reporting on screening demographics.
Richard Durbin
Senator
IL
The Increasing Access to Lung Cancer Screening Act aims to expand access to vital lung cancer screenings and tobacco cessation services. It mandates that Medicaid cover annual lung cancer screenings with no out-of-pocket costs and expands tobacco cessation coverage to all Medicaid enrollees without prior authorization. Furthermore, the bill prohibits prior authorization requirements for annual lung cancer screenings under Medicare and private health insurance plans starting in 2028, alongside funding for education and outreach.
Lung Cancer Screening Act Mandates Zero-Cost Scans and Tobacco Cessation Support by 2028
Lung cancer screening is getting a major overhaul that cuts through the red tape of insurance approvals and out-of-pocket costs. Starting January 1, 2028, this bill requires Medicaid, Medicare, and private insurance plans to cover annual lung cancer screenings without requiring prior authorization—that annoying process where your doctor has to ask the insurance company for permission before you can get a scan. For those on Medicaid, the bill goes a step further by ensuring these screenings come with a $0 price tag, meaning no deductibles or copays can be charged for the service (Section 2).
Clearing the Path to Prevention
Currently, getting a specialized scan or starting a program to quit smoking often feels like navigating a maze of paperwork. This bill aims to knock down those walls. Under Section 4, if the U.S. Preventive Services Task Force recommends a screening for you, your private insurance or Medicare Advantage plan can no longer make you wait for 'utilization management' hurdles. Imagine a 55-year-old former smoker who works construction; instead of waiting weeks for an insurance adjuster to approve a scan, they can get scheduled immediately, potentially catching issues before they become life-threatening. By removing 'prior authorization' requirements, the bill treats these screenings with the same urgency as an emergency room visit.
Support for Quitting, Not Just Screening
In a significant shift for public health, Section 3 expands Medicaid coverage for tobacco cessation—counseling and medications—to every single person enrolled in the program. Right now, these benefits are often restricted primarily to pregnant women. By 2028, any Medicaid recipient looking to quit smoking will have access to professional counseling and quitting aids without needing prior approval or paying a copay. This means a retail manager or a delivery driver on Medicaid can walk into a pharmacy or a clinic and get the help they need to quit without worrying if their specific plan covers it or if they can afford the bill at the end of the month.
Finding the Gaps
Because policy is only as good as the data behind it, the bill also puts $10 million a year toward a massive outreach campaign to educate high-risk communities about these new benefits (Section 5). Perhaps most importantly, Section 6 orders a deep-dive study into who is actually getting lung cancer versus who is currently eligible for screenings. If the study finds that certain groups are getting sick but don't meet the current 'high-risk' criteria for a free scan, the government will have to provide recommendations on how to update those rules. It’s a move intended to ensure the law evolves as our understanding of the disease changes, making sure no one is left out just because they don't fit a decades-old demographic profile.