Does Medicare cover a colonoscopy?
Medicare covers a colonoscopy every 24 months for high-risk people, and every 120 months for those not at high risk. Medicare colonoscopy coverage doesn't require a coinsurance payment and no deductible applies. There is no age requirement to have a colonoscopy covered by Medicare. Medicare Advantage coverage rules may vary, but they will still cover the test at no cost.
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UPDATED: Apr 30, 2021
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Does Medicare cover a colonoscopy? Medicare covers a colonoscopy as a preventive service every 24 or 120 months depending on your level of risk. Since a colonoscopy is a screening tool, Medicare Part B covers the test in full, also do most health insurance companies including Medicare Advantage providers. If something is found that requires removal during the colonoscopy, such as colorectal polyps, you may be responsible for a coinsurance amount for that part of the procedure. Medicare Supplement insurance can help to cover the cost of coinsurance and other out-of-pocket costs.
If you’d like to compare rates for Medicare Supplement insurance to cover any out-of-pocket costs that may result from a covered colonoscopy, we can help. Enter your ZIP code now.
What is the Medicare coverage for a colonoscopy?
A colonoscopy, which screens for colon cancer as well as other conditions, is considered preventative care. Medicare covers this screening colonoscopy in full either every two or ten years depending on your level of risk for colon cancer or other ailments. According to Medicare.gov, there is no age requirement for a colonoscopy.
What is considered regular screening when it comes to preventive colonoscopies?
For high-risk individuals, the screening is covered every 24 months. Risk factors include a family history of colorectal cancer, a personal history of colorectal cancer, polyps, or bowel disease like Chron’s, and a family history of inherited syndromes related to colorectal cancer.
For those that are not at high risk, screening colonoscopy costs are covered once every 120 months, or 48 months after a previous flexible sigmoidoscopy, another screening tool for colon and rectal cancer.
If you have Medicare Advantage, the test frequency or requirements might be different, so check with your insurance company.
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How much does a colonoscopy cost with Medicare?
There’s no out-of-pocket expense for a colonoscopy as long as it follows Medicare’s guidelines for frequency for preventive screening. It is covered in full with no coinsurance or deductible.
However, if the doctor finds a polyp or other tissue that requires removal during the colonoscopy and removes it, that procedure is charged to Medicare differently. In that case, you will have to pay a 20% coinsurance amount. The Part B deductible, however, doesn’t apply in this case.
If you have a Medicare Advantage plan, your coinsurance and deductible amounts may vary, so you will need to check with your plan provider for details. A Medicare Supplement plan can cover the 20% coinsurance cost for removal of tissue during a colonoscopy.
Does Medicare cover a colonoscopy? The Bottom Line
Medicare covers a colonoscopy within timeframes determined by your level of risk, as with most screening tests. There is no cost for this screening procedure and no deductible. You may have different coverage requirements with a Medicare Advantage plan.
To compare the colonoscopy coverage on Medicare Advantage plans, along with rates, enter your ZIP code below.