Based on the US Preventive Services Task Force (USPSTF) grade B recommendation for lung cancer screening,1 commercial insurers operating through Affordable Care Act exchanges, with the exception of certain grandfathered plans, must cover individuals aged < 65 years who meet the USPSTF criteria for CT scan screening without copayments before the end of 2015.2 Thus, for these insurers, the question regarding coverage is settled; all that might be considered is whether the law is reasonable or whether the USPSTF made an improper recommendation. With regard to the Centers for Medicare & Medicaid Services (CMS), the decision will be based on whether they determine the test has a proven benefit to the covered population.3 In making this determination, it is necessary to understand the benefit in terms of potential lives saved compared with potential harms. With lung cancer being the leading cause of cancer death in the Medicare population, the stakes are high. However, should CMS decide not to provide this coverage, the incongruous result would be that those younger and at lower risk would be covered, whereas those at higher risk would not. In a somewhat analogous manner it would also allow for those aged > 65 years with means to pay on their own the opportunity to be screened, whereas poor and probably higher-risk populations would not have access.