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Does Medicare cover a colonoscopy?

En español | Yes. Because Medicare considers a colonoscopy preventive care covered in Part B, you won’t have to pay anything for the screening. But not all colonoscopies are free.

How often Medicare covers the procedure depends on your health and risk factors. In fact, the U.S. Preventive Services Task Force (USPSTF) recommends that Americans get an initial screening for colorectal cancer at age 45.

How often will Medicare cover a colonoscopy?

If you’re not at high risk for colorectal cancer, Medicare will pay the full cost of the screening once every 10 years — or every four years if you’ve undergone a flexible sigmoidoscopy, a similar procedure that doesn’t probe the entire colon. But if your risk for developing colorectal cancer is high, Medicare will cover the full cost of a colonoscopy once every two years.

Medicare considers high risk as having:

  • A personal history of colorectal cancer, such as adenomatous polyps, a form of benign polyp that can become cancerous, or an inflammatory bowel disease, such as Crohn’s disease or ulcerative colitis.

  • A close relative — parent, sibling or child — who had colorectal cancer or an adenomatous polyp.

  • A family history of inherited syndromes linked to colorectal cancer, such as familial adenomatous polyposis or hereditary nonpolyposis colorectal cancer, also known as Lynch syndrome.

Medicare also covers other types of screenings for colorectal cancer, with time frames based on your age and risk factors.

How much do I pay for a Medicare-covered colonoscopy?

Medicare Part B covers the full cost of what it calls a screening colonoscopy, done to prevent rather than diagnose or treat colon cancer. You won’t face any deductible or copayment if your doctor or other health care provider accepts assignment, which means the provider accepts Medicare’s payment in full.

The no-deductible provision applies even if you haven’t met your deductible for the year.

When you’ll be billed. If your doctor finds and removes a polyp or other tissue during the screening, the procedure becomes a diagnostic colonoscopy. Then you may have to pay Part B coinsurance, which is 20 percent of the Medicare-approved amount. But you still won’t have to worry about your Part B deductible, which is $233 in 2022.

This is because Medicare covers eligible preventive screenings in full, such as Pap smears and pelvic exams to check for cervical and vaginal cancer in women, PSA blood tests to look for prostate cancer in men, and cholesterol tests to detect heart disease. But Medicare requires a 20 percent copayment for diagnostic treatment of certain symptoms or risk factors.

Changes begin in 2023. Next year you will pay a lower percentage of the fees for what starts as a free colonoscopy or flexible sigmoidoscopy screening but transforms into a diagnostic procedure while you’re under anesthesia.

  • From 2023 to 2026, the coinsurance rate will be 15 percent.
  • From 2027 to 2029, it will decrease to 10 percent.
  • Starting in 2030, the coinsurance will be waived.

And you still won’t have to meet your deductible first.

No worries if you have Medigap. Any of the 10 types of Medicare supplemental policies available for purchase covers the Part B coinsurance expenses.

Keep in mind

Talk with your doctor about setting up a preventive screening schedule. You can do this during your free Welcome to Medicare visit within the first 12 months of enrolling in Medicare Part B or during your annual wellness visit. These visits, which you don’t have to pay for, are a perfect opportunity to create a personalized health plan for the year.

Updated September 14, 2022

     

        


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