Does Medicare cover a colonoscopy?

Colonoscopies are an important test for early detection of colon cancer and precancerous polyps. Colorectal cancer is most commonly found in adults aged 65 to 74. The American Cancer Society estimates that in 2021, 104,270 new cases of colon cancer and 45,230 cases of rectal cancer emerged¹. Because colon cancer is the third most common type of non-skin cancer in both men and women, and is the second leading cause of cancer death in the United States, early detection of colon cancer is important.¹

If you are on Medicare and have been referred for a colonoscopy, you may have questions about whether your plan will pay for the test. The answer is yes, but there are some limits to how often and when Medicare will cover a colonoscopy. In some cases, you may need to undergo earlier tests or preventive measures.

Does Medicare pay for Cologuard™?

If you don’t show symptoms of colorectal cancer and are covered by Medicare, you have access to the Cologuard^TM multi-target stool DNA test. Cologuard^TM is less invasive than a colonoscopy or flexible sigmoidoscopy. Cologuard^TM works by studying a stool sample for DNA code that can suggest either precancerous polyps or colorectal cancer.

Medicare Part B covers Cologuard^TM once every three years, provided you meet all of the following conditions²:

• You must be between 50 and 85 years old.

• You must show no signs or symptoms of colorectal disease. This includes—but isn’t limited to—lower gastrointestinal pain, bloody stool, a positive fecal occult blood test or a positive fecal immunochemical test.

• You must be at average risk of developing colorectal cancer, but have no personal history of polyps, cancer or inflammatory bowel disease including Crohn’s Disease or ulcerative colitis.

Cologuard™ is one of many Medicare-covered tools to detect colorectal cancer. If you are concerned about the Cologuard™ cost with Medicare, speak with your doctor about it or other colorectal cancer screening methods that are available.

Are colonoscopies covered under preventive care?

Medicare will cover the cost of many preventive care services—such as a screening colonoscopy—on a specific timetable. The frequency of screenings are based on your risk for colorectal cancer. If polyps or other tissues are found and removed, you may pay 20% of the Medicare-approved amount of your services and a hospital copayment. 

The Part B deductible does not apply to colonoscopies. In addition, anesthesia services for a colonoscopy may incur out-of-pocket costs. This is the major difference between a preventive and diagnostic colonoscopy.

How often will Medicare pay for a colonoscopy?

Medicare will pay for a screening colonoscopy once every 24 months (two years) for individuals who are at a high risk of developing colorectal cancer. If you are not high- risk, the test will be covered once every 120 months (10 years) or 48 months (four years) after a flexible sigmoidoscopy. 

What is a colonoscopy?

A colonoscopy is an outpatient procedure in which a healthcare provider looks inside your large intestine. They do this with a flexible camera called a scope. The scope is inserted into the rectum and a small amount of air is pushed into your colon to allow the scope to see the colon walls.

Prior to the procedure, you will undergo bowel preparation that typically involves a low-fiber diet for a few days before the colonoscopy. It also usually involves drinking a liquid bowel preparation product. Drinking the colonoscopy prep through a straw or cooling it in the refrigerator can help make drinking the solution easier.

The goal of this preparation is to completely empty your colon by inducing watery diarrhea. Closely follow all prep instructions, including a mostly liquid diet the day before the procedure. Drinking plenty of fluids will help you avoid becoming dehydrated.

The entire procedure takes about 30 minutes. If polyps need to be removed, it will take longer. You’ll stay in a recovery room after the procedure, although the duration of your stay depends on sedation and pain medication given.

Many colonoscopies are performed under general anesthesia, but you may also choose “twilight,” conscious sedation. Whatever method of anesthesia you choose, you will need someone to drive you home. It’s usually advised to wait until the next day to resume your normal activities.

Importance of Maintaining Your Colon Health

A healthy digestive system includes improving your colon health⁴. Reducing your risk of colon cancer is key to avoiding regular colonoscopies. Some ways on how to improve colon health include:

• Reducing your use of alcohol
• Staying at a healthy weight
• Engaging in moderate to vigorous physical activity
• Eating a balanced diet high in vegetables, fruits, and whole grains
• Reduce consumption of red meats and processed meats
• Avoid smoking

Does Medicare cover endoscopy?

If your doctor recommends an endoscopy to help identify issues related to your gastrointestinal tract, it may be covered under Medicare Part B as an outpatient procedure. Like most procedures covered by Medicare Part B, you’ll be responsible for 20% of the cost of your care if the doctor accepts assignment and is Medicare-approved.

Understand Your Medicare Coverage for Colonoscopies

If you have questions about when and how a colonoscopy is covered by Medicare, it’s best to not delay getting them answered. Maintaining your colon health is an important part of staying healthy as you age. By putting off important screenings, you run the risk of developing colorectal cancer.

AgeFriendly.org's trusted partner can help walk you through the coverage for preventive screenings for colorectal cancer and other diseases, whether you have existing Original Medicare coverage or are shopping for a Medicare Advantage plan. We can also help you compare rates for Medicare coverage to save you time and money.

¹https://www.cancer.org/cancer/colon-rectal-cancer/about/key-statistics.html
²https://www.cancer.gov/types/colorectal/screening-fact-sheet#who-is-at-risk-for-colorectal-cancer
³https://www.medicare.gov/blog/cutting-edge-colorectal-cancer-screening-now-covered
⁴https://www.cancer.org/cancer/colon-rectal-cancer/causes-risks-prevention/prevention.html