Does Medicare Cover Colonoscopy Exams?
Written by: Bryan Strickland
Reviewed by: Selah Lee, Licensed Insurance Agent
If your risk for cancer is low or average, a colonoscopy is recommended every 10 years after you turn 50
Your Medicare Part B will cover preventive screenings for colon cancer
If additional treatment related to your colonoscopy is required during your screening visit, the treatment could be consider diagnostic and coinsurance and Part B deductible apply.
Medicare will cover the cost of a Cologuard test every three years if you qualify
Medicare covers colonoscopies. A colonoscopy protects you against developing colorectal cancer. It is a preventive service, so it will be covered by Part B of Original Medicare. You don’t have to pay a copay or coinsurance, and the Part B deductible doesn’t apply. [i]
A colonoscopy will also be covered under a Medicare Advantage (MA) plan. MA plans must include the same benefits as Medicare Parts A and B.
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How Much Does a Colonoscopy Cost with Medicare?
Thanks to Medicare coverage for colonoscopy exams, a preventative test will be covered for Medicare beneficiaries. Medicare recipients who are at high risk for colorectal cancer are covered for colonoscopies once every 24 months. For all other beneficiaries, they are covered for one colonoscopy every 10 years.
Medicare considers you at high risk and will cover a colonoscopy every 24 months if you have: [i]
- A personal history of colorectal cancer
- An inflammatory bowel disease (i.e., Crohn’s, ulcerative colitis)
- Adenomatous polyps (benign polyps that can be a precursor to colorectal cancer)
- A close relative diagnosed with colorectal cancer or an adenomatous polyp
- A family history of hereditary nonpolyposis colorectal cancer or familial adenomatous polyposis (hereditary conditions with a tendency toward developing colorectal cancer)
Medicare also will cover a colonoscopy if you had a flexible sigmoidoscopy (which tests just the lower colon) at least 48 months ago.
Is a colonoscopy free under Medicare?
If your medical provider accepts Medicare, everything about the colonoscopy procedure is covered unless polyps are found.
Suppose polyps or other tissue are removed during the colonoscopy for analysis. In that case, the procedure is no longer preventive, and you may be subject to the standard 20% coinsurance for Part B services. You may also face a copay if the procedure is in an out-of-office setting where facility fees are typically charged.
Does Medicare Pay for Colonoscopy Anesthesia?
Yes. To encourage people to get this crucial preventive test, the Centers for Medicare & Medicaid Services successfully revised the Affordable Care Act that covered anesthesia costs for colonoscopies beginning in 2015. [i]
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What Age Does Medicare Stop Paying for Colonoscopy?
There is no age limit for colonoscopies under Medicare rules.
The U.S. Preventive Services Task Force recommends colon cancer screening for individuals between the ages 50 and 75. It is recommended as an individual’s decision after age 75. [i]
Does Medicare Cover Cologuard?
Yes, Medicare will cover the cost of a Cologuard test every three years for those who qualify. [i]
Cologuard is the only stool-DNA test approved by the Food and Drug Administration for detecting colorectal cancer. Medicare Part B will cover a Cologuard test every three years if you:
- Are between the ages of 50 and 85.
- Have no symptoms of colorectal cancer and are considered to be at average risk for it.
A colonoscopy is typically preventive but is considered a diagnostic service when it follows a positive Cologuard test. In this instance, you will owe 20% coinsurance with the service.
What extra benefits and savings do you qualify for?