To get lung cancer screening, you need to meet specific eligibility criteria, have a conversation with your doctor, and get a referral for a low-dose CT scan. The process is straightforward, and if you qualify, most insurance plans cover it at no cost to you. Here’s how each step works.
Who Qualifies for Screening
The U.S. Preventive Services Task Force recommends annual lung cancer screening for adults aged 50 to 80 who have a 20 pack-year smoking history and either currently smoke or quit within the past 15 years. That’s the standard most insurers use to decide coverage.
A pack-year is a simple calculation: one pack (20 cigarettes) per day for one year equals one pack-year. So if you smoked two packs a day for 10 years, that’s 20 pack-years. One pack a day for 20 years also equals 20. The math doesn’t have to be exact, and your doctor can help you estimate your history during your visit.
Screening stops once you’ve been smoke-free for 15 years or if you develop a health condition that would make lung cancer treatment unlikely or not feasible.
Your First Step: The Counseling Visit
Before you can get the scan itself, you’ll need a visit with your primary care provider to discuss whether screening makes sense for you. This is sometimes called a “shared decision-making” visit, and it’s a requirement for both Medicare and most private insurance coverage. During this appointment, your doctor will review your smoking history, confirm you meet the eligibility criteria, and talk through the benefits and risks of screening so you can make an informed choice together.
Some clinics use interactive tools that walk you through the key facts before your appointment: how screening affects lung cancer survival, what false positives look like, and what follow-up might involve. These tools also give you space to write down questions for your provider. If your clinic doesn’t offer one, you can simply bring your smoking history details and any questions to the visit. At the end, your provider writes the order for the scan.
What the Scan Is Like
The screening itself is a low-dose computed tomography scan, or LDCT. You lie on a table while an X-ray machine takes detailed images of your lungs using a lower amount of radiation than a standard CT scan. The whole thing takes just a few minutes, requires no injections or contrast dye, and is completely painless. You don’t need to fast or do any special preparation beforehand.
Where to Get Screened
Not every imaging center runs a dedicated lung cancer screening program. The American College of Radiology designates certain facilities as Lung Cancer Screening Centers, which means they meet specific standards for equipment, radiologist expertise, and patient follow-up. You can search for accredited facilities on the ACR website. Your doctor’s office can also refer you to a nearby program, and many large hospital systems now operate their own screening clinics.
Choosing a designated center matters because these programs use standardized scoring systems to read your results, and they have protocols in place to track any findings over time rather than losing you in the shuffle.
What Your Results Mean
Your scan results are scored using a system called Lung-RADS, which assigns a category based on what the radiologist sees. Most results fall into lower categories that require nothing more than your regular annual screening. A category 2 result, for example, means the scan found something small and almost certainly harmless, like a tiny nodule, and you simply return for your next annual scan in 12 months.
A category 4A result means something looks indeterminate and needs a closer look, typically a follow-up CT scan in about three months. If that follow-up shows the finding is stable or smaller, it gets downgraded to a lower category, and you move back toward routine annual screening. Only a small fraction of findings ultimately require a biopsy or further intervention. The stepped approach is designed to avoid unnecessary procedures while still catching anything that needs attention early.
False Positives Are Common
One thing to prepare for: LDCT screening has a relatively high false-positive rate. Across large studies, roughly 20% of baseline scans flag something that turns out not to be cancer. That number drops on subsequent annual scans, falling to around 10% in some trials. Most false positives involve small lung nodules that are benign, such as old scars from infections or minor inflammation.
A false positive doesn’t automatically mean invasive testing. The majority of flagged findings are simply monitored with a follow-up CT scan a few months later. In large screening trials, only about 1% to 4% of all screened individuals ended up having a nonsurgical biopsy, and surgical removal of a nodule happened in roughly 1% to 6% of cases. Among those who did have surgery, a meaningful portion turned out to have benign tissue. This is worth understanding upfront so an abnormal-sounding result doesn’t cause unnecessary panic.
Why Screening Is Worth It
The National Lung Screening Trial, the landmark study that shaped current guidelines, found that screening with LDCT reduced lung cancer deaths by 20% compared with standard chest X-rays. That’s a significant benefit, and it’s the reason guidelines now recommend annual screening for eligible adults. Lung cancer caught early through screening is far more treatable than lung cancer found after symptoms appear, when it has often already spread.
What Screening Costs
Under the Affordable Care Act, most private insurance plans are required to cover lung cancer screening with no out-of-pocket cost, including no copays or deductibles, as long as you meet the eligibility criteria. However, grandfathered plans that existed before the ACA was passed may not be required to provide the same coverage, so it’s worth checking with your insurer.
Medicare Part B covers annual LDCT screening for adults aged 50 to 77 who meet the smoking history requirements, have no symptoms of lung cancer, and get an order from their provider. You pay nothing if your provider accepts Medicare assignment. Note that Medicare’s upper age limit is 77, slightly lower than the USPSTF’s recommendation of 80, so if you’re between 78 and 80, your coverage situation depends on your specific plan.
If you don’t have insurance or your plan doesn’t cover screening, the out-of-pocket cost for an LDCT scan varies by facility but typically ranges from a few hundred dollars. Some screening programs offer reduced rates for self-pay patients.
How Often You’ll Need to Return
Lung cancer screening is not a one-time event. The recommendation is to get an LDCT scan every year for as long as you meet the eligibility criteria. That means annual scans continuing until you turn 80, until you’ve been smoke-free for 15 years, or until a health condition makes further screening unlikely to benefit you. Each annual scan is a fresh look at your lungs, and cancers can develop between screenings, which is why consistency matters. If you skip a year, simply schedule your next scan as soon as possible rather than waiting for the following year.