Does Medicare cover a colonoscopy?

Few things are as unpleasant to think about as a colonoscopy. In fact, the only thing less pleasant to think about than a colonoscopy is the cost of a colonoscopy. Fortunately if you are age 65 or over and enrolled in Medicare, you can avail yourself of colonoscopy cancer screening coverage on an outpatient basis.

Original Medicare’s Part B plan covers outpatient colonoscopy procedures. However, the extent of said coverage depends on the beneficiary’s prior medical history. If you are at a high risk for colorectal cancer, Medicare grants you one test every two years. Medicare defines “high risk” as having a family history of the disease, having had colorectal polyps or colorectal cancer, or having had inflammatory bowel disease. If you are not at high risk, Medicare allows for one test every ten years, though not within four years of a flexible sigmoidoscopy procedure.

Additional services

In addition to colonoscopies, Medicare covers a fecal occult blood test once every 12 months in persons 50 years of age or older. It offers a flexible sigmoidoscopy once every four years for high risk beneficiaries. Medicare offers a barium enema once every two years for high risk beneficiaries and once every four years for low risk persons. These cannot be within four years of a flexible sigmoidoscopy procedure. Finally, Medicare offers a multi-target stool DNA test, which is an at-home procedure administered every three years for beneficiaries who meet the following conditions.

  • You must be between the ages of 50 and 85.
  • You must show no signs of colorectal disease including gastrointestinal pain, blood in stool, a positive fecal occult blood test, or a positive fecal immunochemical test.
  • Beneficiaries must also demonstrate they’re at average risk of developing colorectal cancer.

Under Medicare Part B, no co-insurance or deductible charges apply to the fecal occult blood test, the flexible sigmoidoscopy, or the colonoscopy if you see a Medicare-approved doctor for the procedure. Barium enemas require you to pay 20% of the Medicare-approved amount, but the Part B deductible does not apply. While the colonoscopy is covered, the removal of any polyps that are discovered during the procedure is not covered by Medicare. You will be responsible for co-insurance payments (but not the deductible) for the removal.

In addition to Medicare Part B, Medicare Part C (sometimes called Medicare Advantage) will sometimes cover colonoscopies and related procedures. Part C is required to cover everything that is provided under Original Medicare Parts A and B, but it sometimes provides additional coverage that may further reduce the costs of colonoscopies. Part C co-payments may also differ from Part A and Part B, so you should contact your Part C/Advantage provider and ask them about colonoscopy and related coverage.

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