Does Medicare Cover Endoscopy?

Medicare typically does cover an endoscopy that is deemed medically necessary by a doctor.

Medicare Advantage (Part C) plans may also cover an endoscopy that is deemed medically necessary. Medicare Advantage plans also include an annual out-of-pocket spending limit. This can potentially save you money in Medicare costs for your endoscopy.

Original Medicare does not include an out-of-pocket spending limit.

A nurse smiles in the hospital

When does Medicare cover a colonoscopy or other endoscopy?

Endoscopies are typically an outpatient procedure. Depending on where your endoscopy is performed, Original Medicare (Medicare Part A and Part B) may cover some of your costs:

  • Any doctor’s services related to the endoscopy are typically covered by Medicare Part B (Medical Insurance).

  • If you receive the endoscopy as an inpatient, hospital and inpatient care costs related to the endoscopy are typically covered by Medicare Part A (Hospital Insurance).

An endoscopy is a non-surgical procedure that examines a patient’s digestive tract using a flexible tube with a light and camera, called an endoscope.

For upper endoscopies, the endoscope is passed through the mouth to examine one or each of the following:

  • Esophagus
  • Stomach
  • Small intestine

For lower endoscopies, the endoscope can be passed into the large intestine through the colon. This is often called a colonoscopy.

Medicare Part B will cover a colonoscopy once every two years if you have a high risk for colorectal cancer, or once every ten years if you are not at a high risk.

Another type of lower endoscopy is called a flexible sigmoidoscopy.

Medicare Part B covers screening flexible sigmoidoscopies once every two years for most beneficiaries who are age 50 or older. They may be covered once every ten years after your initial screening, if you’re not at high risk for colorectal cancer.

How much does an endoscopy cost with Medicare?

Depending on the type of endoscopy you receive (colonoscopy or other type of test), you may responsible for paying the Part B deductible and/or Part B coinsurance.

If your doctor or health care provider accepts Medicare assignment, you pay nothing for qualified screening colonoscopies or screening flexible sigmoidoscopies.

We recommend speaking with your doctor directly for specific cost and coverage information related to your endoscopy.

Most Medicare Advantage plans offer additional benefits

Medicare Advantage plans are sold by private insurance companies as an alternative to Original Medicare (Medicare Part A and Part B).

Every Medicare Advantage plan must cover everything that Part A and Part B covers, and most Medicare Advantage plans cover prescription drugs.

If your endoscopy is covered by Original Medicare, it will also be covered by a Medicare Advantage plan.

A licensed insurance agent can help you learn more about your Medicare Advantage plan options and find a plan that fits your coverage needs. If you’re eligible to enroll, compare plans today and call to speak to a licensed agent.

 

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