Your Medicare Coverage

Is my test, item, or service covered?

Colorectal cancer screenings

How often is it covered?

Medicare Part B (Medical Insurance) covers several types of colorectal cancer screening tests to help find precancerous growths or find cancer early, when treatment is most effective. One or more of these tests may be covered:

  • Barium enema: When this test is used instead of a flexible sigmoidoscopy or colonoscopy, Medicare covers it once every 48 months if you're 50 or over and once every 24 months if you're at high risk for colorectal cancer.
  • Multi-target stool DNA test (like Cologuard™): Medicare covers this test once every 3 years for people who meet all of these conditions:
    • They’re between 50–85.
    • They show no signs or symptoms of colorectal disease including, but not limited to, lower gastrointestinal pain, blood in stool, positive guaiac fecal occult blood test or fecal immunochemical test.
    • They’re at average risk for developing colorectal cancer, meaning:
      • They have no personal history of adenomatous polyps, colorectal cancer, inflammatory bowel disease, including Crohn’s Disease and ulcerative colitis.
      • They have no family history of colorectal cancers or adenomatous polyps, familial adenomatous polyposis, or hereditary nonpolyposis colorectal cancer.
  • Colonoscopy: Medicare covers this test once every 24 months if you're at high risk for colorectal cancer. If you aren't at high risk for colorectal cancer, Medicare covers this test once every 120 months, or 48 months after a previous flexible sigmoidoscopy.
  • Fecal occult blood test: Medicare covers this lab test once every 12 months if you're 50 or older.
  • Flexible sigmoidoscopy: Medicare covers this test once every 48 months for most people 50 or older. If you aren't at high risk, Medicare covers this test 120 months after a previous screening colonoscopy.

Who's eligible?

All people age 50 or older with Medicare are covered. People of any age are eligible for a colonoscopy.

Your costs in Original Medicare

  • For barium enemas, you pay 20% of the Medicare-approved amount for the doctor's services. In a hospital outpatient setting, you also pay a copayment.
  • In 2015, you pay nothing for a multi-target stool DNA test (like Cologuard™).
  • If a screening colonoscopy test results in the biopsy or removal of a lesion or growth during the same visit, the procedure is considered diagnostic and you'll have to pay coinsurance or a copayment.
  • You pay nothing for the fecal occult blood test. This screening test is covered if you get a referral from your doctor, physician assistant, nurse practitioner, or clinical nurse specialist.
  • You pay nothing for the flexible sigmoidoscopy or screening colonoscopy, if your doctor accepts assignment.
Note

To find out how much your specific test, item, or service will cost, talk to your doctor or other health care provider. The specific amount you’ll owe may depend on several things, like other insurance you may have, how much your doctor charges, whether your doctor accepts assignment, the type of facility, and the location where you get your test, item, or service.

Note

Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. It’s important to ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them.

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