Medicare coverage is necessary for colonoscopy screenings. Colonoscopies are an essential part of preventive health care for those fifty years and older. Colorectal cancer is the third most common kind of cancer in the United States.
Early detection through screening is the best way to prevent localized cancer from becoming a much more severe problem. Early detected colorectal cancers are treatable and, when found soon enough, there is a 90% five-year survival rate.
Because most colon cancers develop after the age of 65, it’s important for Medicare recipients to get colonoscopies when their doctors recommend they do so.
General practitioners can refer patients to gastroenterologists who can perform colonoscopies, and when patients are encouraged to have a colonoscopy, they should follow through. While the prep can be less than pleasurable, the life-saving screening is worth the effort.
Medicare Coverage for Colonoscopy Screenings
Part A, which covers hospital stays, is not relevant to colonoscopies, which are outpatient procedures, meaning that patients do not require overnight stays in the hospital.
Medicare Part B covers colonoscopies, with the following guidelines:
- The Part B deductible does not apply to this procedure
- If you go to a Medicare-assigned physician, you will pay nothing for a screening colonoscopy
- If there are any abnormalities found during the procedure, it becomes a diagnostic colonoscopy. You are then responsible for 20% of the cost, based on what amount Medicare approves
- If you are in a hospital setting, you may have a co-payment. Discuss with your physician how to avoid this cost, and make sure you see a Medicare-approved doctor for this and any medical care
It’s a good idea to have a Medigap plan in place before having a colonoscopy, as it will cover whatever costs arise beyond the Medicare-approved amount. Medigap plans are a safety net that all Medicare Parts A & B enrollees should have.
How Often Are Colonoscopies Allowable on Medicare?
For high-risk patients, Medicare covers colonoscopies every 24 months, and every four to ten years for those at average risk, depending on the individual’s situation.
Screenings are vitally important for both the treatment and survival of colorectal cancer. At this time there are approximately one million Americans who have beaten colorectal cancer and are alive due to the medical care after diagnosis through a colonoscopy.
Approximately one in four people will develop colon cancer in his or her lifetime. Take the right steps to make sure you do everything possible to prevent colon cancer.
Some of the factors that indicate a higher need for colonoscopy include:
- Male or female – men are more likely to get colon cancer
- Race – African Americans have a higher likelihood of getting colorectal cancer
- Health history – gastrointestinal and bowel diseases such as inflammatory bowel disease or Crohn’s disease indicate the higher probability of developing this type of cancer
- Obesity or a history of tobacco use can be contributing factors
- Family history – if your family has a history of colon cancer
Symptoms That Indicate Medicare Coverage for a Colonoscopy in Necessary
Along with prevention, colonoscopies are used for diagnoses when specific symptoms present in patients – and not only in those who are 65 and over.
Some are embarrassed to discuss these symptoms with their doctors, but ignoring them can be a deadly mistake. Not everyone with symptoms will receive a diagnosis of colorectal cancer, but those 65 and over must be extra-vigilant.
Symptoms that might call for colonoscopy include:
- Unusual bleeding from the area
- Changes in daily bowel movements
- Unexplained abdominal pain
- Significant weight loss
If your enrolled in Medicare, or new to Medicare, and need help navigating the Medicare maze, give us a call today! We can help compare plans in your area to give you peace of mind. You can also complete our online rate form to see rates near you.
Does Medicare cover Avastin?
Yes, Avastin is a Part B drug with approval by the FDA for the treatment of various forms of cancer. Remember, Medicare beneficiaries are generally responsible for 20% of this amount in the form of coinsurance. If you have a Medicare Supplement Plan, that 20% will be covered.