Is a colonoscopy covered by Medicare?
Does Medicare cover a colonoscopy? Yes they do, as part of regular screenings for cancer. Diagnostic colonoscopies will also be covered by Medicare as long as they are medically necessary. Medicare Part B will cover a colonoscopy at 80%, but a Medigap plan can help pay the remaining expenses.
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UPDATED: Nov 19, 2021
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- Colonoscopy costs with Medicare depend on whether the colonoscopy is being performed for screening or diagnostic purposes
- Medicare may ask you to pay a portion of the bill if your doctor finds a polyp or takes other tissue samples during a colonoscopy
- Medigap can help cover out-of-pocket costs
A colonoscopy is an important screening tool. By identifying conditions in their early stages, doctors can lessen the complications that come with later shifts in health. So, does Medicare cover a colonoscopy?
Colon cancer is the fourth most common type of cancer in the U.S. and is the second most common cause of cancer death. So it’s important to get screened, and it’s important to know how much it will cost. We’ll help you understand how health insurance coverage with Medicare, and particularly colonoscopy insurance coverage with Medicare, works.
Keep reading to find out if Medicare covers a colonoscopy. Enter your ZIP code into our free tool to compare Medicare quotes in your area.
Does Medicare cover colonoscopy screenings?
Any Medicare-approved colonoscopy coverage will depend on how often you have the test and whether the test is for screening or diagnostic reasons.
However, since Medicare does cover screenings for cancer, a colonoscopy will be covered in most cases. Diagnostic coverage is also available, as long as it’s done for a medically necessary reason. In other words, the doctor discovers something that requires diagnosis.
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How much does a colonoscopy cost with Medicare?
Medicare will most likely cover the full cost of a screening colonoscopy once every two years. Take a look at how the parts of Medicare cover different aspects of coverage.
|Medicare Part A||Covers hospital-related costs; if you require inpatient care in a hospital, Medicare Part A is the portion of insurance that pays for these costs||Medicare may require you to pay a copay or deductible for services you receive in the hospital; this is usually one lump sum for up to 60 days of a hospital stay|
|Medicare Part B||Pays for medical services and preventive care; this is the part that covers outpatient care like a colonoscopy||Medicare doesn’t require you to meet your deductible before it’ll pay for a colonoscopy, and they’ll pay regardless if the colonoscopy is for screening or diagnostic purposes|
|Medicare Part C||Includes Part A, Part B, and some prescription drug coverage; the Medicare Advantage plan must cover screening colonoscopies||The major consideration if you have Medicare Part C is to ensure the doctor and anesthesia providers are in-network for your plan, since many Medicare Advantage plans require you to seek care with specified providers|
|Medicare Part D||Prescription drug coverage a person may purchase in addition to their other Medicare parts; some Medicare Part D plans may cover prescriptions for a bowel preparation to help clean out the colon prior to a colonoscopy||Your Medicare Part D plan will come with an explanation of what medications are covered and which ones are not|
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But how often are you supposed to get a colonoscopy?
Here’s the breakdown:
- Once every 24 months: this is for people who have a higher-than-average risk of colorectal cancer due to a family or personal history of the disease
- Once every 48 months: Medicare will fund this after a person has had a flexible sigmoidoscopy
- Once every 120 months: people who are not at increased risk of colorectal cancer will get coverage for a test every 10 years
Coverage changes if the doctor views or removes polyps or other tissue during the procedure. Then the colonoscopy screening becomes a diagnostic rather, and different coverage rules apply.
After your colonoscopy Medicare coverage kicks in, you will be responsible for the remaining 20%. A copayment may also be required if you have the procedure in a hospital.
Medicare Supplement insurance, or Medigap, can help cover the out-of-pocket costs. The average supplemental insurance cost for Medicare will always vary state-to-state and between which policy you end up choosing.
Although undergoing a diagnostic colonoscopy has some financial impact, it is important to remember that the cost of treating cancer is much higher than that of preventive screening.
Why do I need a colonoscopy?
Using a colonoscopy to identify and remove precancerous growths before they progress and become malignant is a vital part of cancer prevention.
Colonoscopies are one of the most common screening tests for colorectal cancer. As many as 19 million colonoscopies are performed every year in the United States.
The procedure not only allows your doctor to see the inside of the colon but also allows them to biopsy any abnormal findings, like colon polyps, to see if they are cancerous.
Studies have shown colonoscopies to be 65% effective in preventing death from cancer on the right side of the colon and 75% from left-sided and rectal cancers.
According to the U.S. Preventive Services Task Force, they recommend individuals have a colonoscopy beginning at age 50 and continuing until they’re at least 75.
Is a colonoscopy covered by Medicare? The Bottom Line
Costs for a colonoscopy will always depend on whether your doctor accepts assignment with Medicare. It also depends on the coverage you have.
A doctor may determine that you’re at high risk if you have a family history of colon cancer or you have a history of colon polyps. If that’s the case, you may have more frequent colonoscopies covered.
But if you’re not at high risk for colon cancer, Medicare will pay for a colonoscopy once every 10 years. Medicare will also cover a diagnostic colonoscopy when necessary.
Now that you’ve learned Medicare coverage for a colonoscopy enter your ZIP code into the free tool below and start comparing Medicare quotes in your area.