Are commercial payers required to provide 100 percent coverage for low-dose computed tomography (LDCT) screening, or can patients be billed for co-pays and deductible?
Most health plans must cover LDCT with no patient co-pay or deductible. The Affordable Care Act requires that health plans must cover without patient cost-sharing those services that have an A or B recommendation from the U.S. Preventive Services Task Force.
However, those plans that are “grandfathered” do not have to follow this. Grandfathered plans must have been in existence prior to March 23, 2010, and cannot make significant changes to their coverage (for example, increasing patient cost-sharing, cutting benefits, or reducing employer contributions). According to an article from Kaiser Family Foundation, in 2014, 26 percent of workers covered in employer-sponsored plans were still in grandfathered plans, and it is expected that over time almost all plans will lose their grandfathered status.