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. Many Medicare Advantage plans also offer prescription drug coverage and benefits such as home meal delivery, both of which are not covered by Medicare Part A and Part B.
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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.
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:
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.
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.
Yes. If you are not considered to be at high risk for colorectal cancer, Medicare will cover a colonoscopy once every 120 months.
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.
Original Medicare does not provide coverage for colonoscopy preparation kits.
Many Medicare Part D and Medicare Advantage plans that include prescription drug coverage, however, may include benefits for colonoscopy preparation.
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.
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 some Medicare Advantage plans even offer additional 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.
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Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.
His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.
Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism. He currently lives in Raleigh, NC.
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