Does Medicare Cover Colonoscopy Screenings?

Medicare Part B covers colorectal cancer screenings

Yes, Medicare Part B covers colonoscopy screenings if you have a high risk of colorectal cancer. It will pay for a colonoscopy once every 24 months.

Medicare Advantage plans (Medicare Part C) also cover colonoscopy screenings. 

Colonoscopies and other colorectal screenings can be helpful in detecting precancerous polyps or colorectal cancer at an early stage. These fall under Medicare’s definition of preventive and screening services.

If you don’t have a high risk for colorectal cancer, Medicare Part B will cover a colonoscopy once every ten years, or 48 months following a flexible sigmoidoscopy. Medicare Part B may also help cover other types of colorectal cancer screenings.

How much do colonoscopy screenings cost with Medicare?

As long as your doctor accepts Medicare assignment — meaning they accept Medicare’s reimbursement for your procedure as payment in full — a colonoscopy and certain other colorectal screenings are covered 100 percent by Medicare Part B.

In addition to colonoscopies, Medicare Part B may the following colorectal screenings at no cost to you if you meet the required guidelines:

• Screening fecal occult blood test
  Medicare covers this screening once every 12 months at no cost if you receive a referral from a doctor, physician’s assistant, nurse practitioner or clinical nurse specialist.
  
  
• Multi-target stool DNA test (Cologuard)
  Medicare covers this test at no cost once every three years if you are at average risk of colorectal cancer, show no signs of symptoms of colorectal disease and are between the ages of 50-85.
  
  
• Screening flexible sigmoidoscopy
  This screening is covered by Medicare at no cost (typically once every 48 months) if you are 50 or older and your doctor accepts Medicare assignment. If you aren’t at high risk for colorectal cancer, it is covered every ten years following a screening colonoscopy.

Medicare Part B will also help pay a portion of another screening test, called a screening barium enema. However, you are typically responsible for 20 percent of the Medicare approved amount. You’ll also pay a copayment if it is performed in a hospital outpatient setting.

If you are 50 or older, a screening barium enema is covered every 48 months, or every 24 months if you have a high colorectal cancer risk.

Will Medicare cover diagnostic procedures?

It’s important to note that a screening colonoscopy or flexible sigmoidoscopy can become a diagnostic procedure if a growth is found and it is biopsied or removed.

If your screening becomes diagnostic in nature, you can expect to pay 20 percent of the Medicare-approved amount of the procedure, plus a copayment if it is performed in a hospital outpatient setting.

Will Medicare cover a colonoscopy if you're not high-risk?

Yes. If you are not considered to be at high risk for colorectal cancer, Medicare will cover a colonoscopy once every 120 months.

Screening flexible sigmoidoscopy

Medicare Part B also covers colonoscopies for beneficiaries who aren't at high risk for colorectal cancer 48 months after a previous flexible sigmoidoscopy.

There is no minimum age requirement for those who aren't considered at high risk, and the same deductible and coinsurance apply. 

Does Medicare cover colonoscopy preparation?

Original Medicare does not provide coverage for colonoscopy preparation kits.

Many Medicare Part D and Medicare Advantage Prescription Drug (MA-PD) plans, however, may include benefits for colonoscopy preparation. 

Will Medicare cover polyp removal?

If a polyp is found during a covered colonoscopy, Medicare Part B will cover the removal of the polyp during the colonoscopy.

You will owe 20% of the Medicare-approved amount. The Part B deductible does not apply in this case.  

Medicare Advantage plans cover colonoscopy screenings

Are you ready to learn more about Medicare benefits and Medicare enrollment? Did you know that Medicare Advantage plans (Medicare Part C) cover the same benefits as Original Medicare (Medicare Part A and Part B)?

Did you know that Medicare Advantage plans can also offer benefits that Original Medicare doesn’t cover?

Give a licensed insurance agent a call today. They can help explain the preventive services like colonoscopy screenings and other benefits that may be covered by Medicare Advantage plans in your area.

Or call 1-800-557-6059 (TTY: 711) to speak with a licensed insurance agent. We accept calls 24/7!

About the author

Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.

Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.

Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.

Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.

A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.

If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.

 

 

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