Medicare will cover Cologuard. Most people with Medicare won’t be responsible for co-insurance if they get a Cologuard kit. Reaching the next stage of life presents new screenings that you should talk to your doctor about. One of several options is Cologuard; however, your doctor or healthcare provider must give you a prescription.
Find Medicare Plans in 3 Easy Steps
We can help find the right Medicare plans for you today
How Often Does Medicare Pay for the Cologuard Test?
Medicare Part B will cover the Cologuard test once every three years if you meet the following criteria.
- At average risk
- Age 50-85
- Asymptomatic
You should have a good understanding of what will affect your screening for colorectal cancer. The Affordable Care Act requires insurance companies to abide by the USPSTF recommendations for coverage. Rated by the USPSTF, if a screening test has an A or B rating, private insurance providers are required to cover the price of the exam. They may not charge these patients a co-pay for this exam.
Medicare is exempt from this requirement; beneficiaries might be responsible for paying coinsurance or co-payments. Look over your plan, make sure you have a good understanding of what type of insurance you have, and what service options your plan covers for colorectal screening, including Cologuard.
How Much is Cologuard with Medicare Coverage?
Depending on the type of insurance will determine the price for the Cologuard blood test, for some, it may be higher or lower. The price of the test can range from $400-$600. Although, talking with your insurance provider can help; you can request fees for the test and laboratory be covered.
You don’t know unless you ask. More than 92% of all patients have a $0 out-of-pocket cost for testing. For eligible patients ages 50-75, with an average risk for colon cancer, without any symptoms, it should be covered by the majority of private health insurance providers.
What are the Screening Guidelines for Cologuard Under Medicare?
The U.S. Preventative Services Task Force guidelines (USPSTF) for screening for colorectal cancer do NOT include the testing of stool DNA. On the other hand, several agencies and societies do review these tests.
Agencies include the Joint Guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. All of which, suggest stool DNA tests (like Cologuard) for the detection of colorectal cancer.
Does Medicare Advantage Cover Cologuard?
Beneficiaries with Medicare Advantage plans or other insurance plans besides Medicare may need to come out-of-pocket for some expenses. Any Medicare member and those with other insurance types whether private or public should contact their insurance plan provider about coverage.
Find Medicare Plans in 3 Easy Steps
We can help find the right Medicare plans for you today
Does Medicaid Cover Cologuard?
For the creators of Cologuard to submit claims to your state Medicaid plan for payment purposes, Exact Sciences Laboratories must be a Medicaid provider in your state. They’re not on contract with Medicare in every state; for instance, in New York, Cologuard is a preventative service for Medicaid members. Then, some states will allow Exact Sciences to contact directly Medicaid plans in the states they’re not participating.
If you don’t see your state, don’t worry because Cologuard is adding new states and plans all the time. Check back often, and if you’re considering canceling your test, call their Customer Care Center first. You can request more information about the financial assistance program that Exact Sciences offers. Members have qualified for a 100% discount.
How to Get Medicare to Cover Cologuard 100%
Of course, there are some exceptions that will apply. No two situations are identical. Your insurance plan provider will confirm the costs. You can contact Medicare about how they cover Cologuard in your state.
Prior to any colorectal or medical screening test, you should understand your coverage and what out-of-pocket expenses you’ll be responsible for. Those with Medigap plans are usually protected against high out-of-pocket costs.
Also, contacting a broker at the phone number above can save you money on out-of-pocket costs. However, if you can't call right now, we understand. Fill out an online rate form and discover your best plan options.
Enter ZIP Code
Enter your ZIP code to pull plan options available in your area.
Compare Plans
Select which Medicare plans you would like to compare in your area.
Get Quote
Compare rates side by side with plans & carriers available in your area.
Does Medicare cover cologuard for an 86-year old during a Wellness visit?
Sara, great question! If you meet the criteria, Cologuard is typically covered by Medicare once every three years.
I had a cologuard 6/2021 (it was NORMAL) and scheduled to get a colonoscopy 2/022. Due to low iron and some bleeding. Will medicare pay for the colonoscopy?
Dana, great question! Medicare will pay for the colonoscopy; however, you could be required to pay coinsurance or deductible as this would be a diagnostic test due to the bleeding and low iron.
Does Medicare pay for a follow up colonoscopy after a positive Cologuard result?
Hi Juliana. Yes, Medicare should cover it.
If I have a medicare advantage (kaiser) will my Medicare still pay for cologuard?
Hi Terri! Since Medicare Advantage varies from plan to plan, you would need to reach out to the carrier directly to find out if it’s covered.
Does a standard guiac test for occult blood in the stool (giving a stool sample to your doctor), count as a screening, if it was done 1 year prior to a Cologuard screening? Would Medicare still cover the Cologuard test?
Hi Leonora! If the test was done as a colon cancer screening, then Medicare won’t cover any other colon cancer screening done within three years of the last screening. The only exception is if you’re high-risk. If you’re considered high-risk, Medicare will cover a screening every two years. I would reach out to your doctor and ask since it depends on how they billed Medicare for the initial test of your stool.
In one place it says Medicare will pay for the Cologuard test once every 3 years and in the above reply it says they pay for one each year. Which is correct?
Hi Linda! Thank you so much for pointing that out. You are correct, it’s every 3 years. Medicare will cover a colon screening every 2 years if you are at high risk.
Why is there a cutoff at 85? I am 94 and would like the test but the cost is a problem.
Hi Whiteford! The concern is those over 85 are at higher risk of colon cancer. This Cologuard test is meant for those who are not high-risk. That’s why there’s a cutoff age.
I just received a $665.00 bill for a cologuard test ordered by my doctor. I’m 68 with average to low risk. Medicare declined paying for the test. My next screening is in 3 years. I thought the test was covered by Medicare.
Hi Debra! I would reach out to Medicare directly to find out why they declined to pay for the test. CMS does state that Cologuard is covered under Part B. It could be something as simple as the billing department from your physicians office used the wrong CPT code.
I just received notice that Medicare will not pay my coloquard test…im 71 Medicare n aarp..I had a different test like coloquard a few months ago but my gi dr ordered coloquard said better..I am afraid of colonosopy because of scar tissue from previous surgeries…
Hi Sandra! If you had a test a few months ago to screen for colon cancer, that’s probably why Medicare declined the test. Medicare will only pay for a screening once every 3 years. They will pay for a screening once every 2 years if you are high-risk.