What is a colonoscopy?
A colonoscopy is a way to look inside a person’s large intestine. Colorectal cancer screenings may help find warning signs of cancer in the colon. These signs are often growths, which can be safely removed or given early-stage treatment. Different tests can also be performed during these screenings.
A colon exam checks for colon cancer and rectal cancer.These are two of the most common cancers. They are a leading cause of cancer death in the U.S.* If you have a higher risk of getting one of these cancers, you should think about getting a screening colonoscopy (a colonoscopy that checks for disease) sooner based on medical necessity. Colon and rectal cancer can be more likely with a history of irritable bowel disease (IBS) and other intestine-related issues. Learning to manage your health using your Medicare benefits is important, no matter the risk.
Does Medicare cover a colonoscopy?
Yes, Medicare covers a colonoscopy. But how often it’s covered and your out-of-pocket cost can vary.
How often do I need a colonoscopy?
If you’re at high risk for colorectal cancer, Medicare covers screening colonoscopies once every 24 months. If you aren’t at high risk, Medicare still covers a colon test once every 120 months, or 48 months after a previous flexible sigmoidoscopy (a procedure that uses a small tube and small camera to check the lower colon). Depending on whether your doctor accepts Medicare, you may pay nothing for the screening test(s). Or you may have some out-of-pocket costs. If you’re thinking about a Medicare Advantage plan (or you already have one), you may have access to more preventive services than you might with an Original Medicare plan.
When should you get your first colonoscopy?
The age you get your first colonoscopy can depend on your medical history. But most adults should think about having a colon check when they turn 45.
How much does a colonoscopy cost with Medicare coverage?
The cost of a colonoscopy can vary. It depends on your other insurance (if any), your doctor’s fees and other things. You might also have to pay extra fees, like a colonoscopy facility fee. The Medicare cost for a colonoscopy may be low. In some cases, Medicare may cover the full cost of screenings. But not all colonoscopies are fully covered by Original Medicare. Learn more about Medicare costs before you get a colonoscopy.
Does Medicare cover the cost of diagnostic colonoscopies?
A diagnostic colonoscopy is used to learn more about any health issues. It might be used to collect a sample of tissue. Or it can be used for growth removal. Your doctor might recommend a lump that was found during a colonoscopy to be studied for signs of cancer. Your diagnostic colonoscopy cost might be partially covered by a Medicare insurance plan. If you have Original Medicare (Parts A and B), you will pay 15 percent of the Medicare-approved amount. You will also pay a 15 percent coinsurance fee for the facility. With a Medicare Advantage plan, you may pay less, or nothing at all.
What is a Medicare Advance Beneficiary Notice of Noncoverage (ABN) form?
A Medicare Advance Beneficiary Notice of Noncoverage (ABN) is a form your doctor gives you. It explains what your Medicare health plan will cover and why, and a final cost estimate. Your doctor has to give you an ABN form before performing any service, including a colonoscopy.
How often will Medicare pay for a colonoscopy?
Colonoscopy coverage depends on your risk of colorectal cancer, which is a term for both colon cancer and rectal cancer. Medicare covers colonoscopy costs one time every 10 years if you are not at a high risk of colorectal cancer. If you do have high risk factors for colorectal cancer, a Medicare coverage plan may cover a colonoscopy screening every two years. These risk factors depend on your personal and family health history.
If you’re planning a colonoscopy, choosing the right Medicare coverage matters. Explore Medicare plans to find coverage that supports your care needs.
