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Medicare Coverage for Colonoscopy Screenings

As we age, we begin to require additional screenings to safeguard our health. For most, a colonoscopy is one of these crucial screenings. Doctors perform colonoscopy exams to check for abnormalities within the colon and rectum.So an essential question in retirement is: does Medicare cover colonoscopy?

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Even if you are experiencing no symptoms of an abnormality, a colonoscopy exam can help prevent future health complications.

Below, we will review when and how often Medicare covers colonoscopy exams.

Medicare Coverage for Colonoscopy Screenings

Original Medicare will cover your colonoscopy exam by a Medicare-accepting physician. The frequency of Medicare coverage for colonoscopy screenings is as follows:

  • Once every 24 months: For those at risk of colorectal cancer due to a personal or familial history of the disease.
  • Once every 48 months: Medicare will cover a colonoscopy at this interval once a person has a flexible sigmoidoscopy procedure. In this exam, the doctor will insert a colonoscope into the sigmoid colon but no deeper.
  • Once every 120 months: For those not at increased risk of colorectal cancer.

When you receive a colonoscopy exam during your approved timeframe, Medicare will cover 100% of the cost as a screening procedure. Thus, you will not be responsible for paying for anything out-of-pocket for the service. Medicare will also cover this cost if you require anesthesia for your colonoscopy procedure.

Should your doctor find a polyp or another abnormality through your colonoscopy, the screening status will change to diagnostic. Thus, different coverage rules will apply.

Medicare Coverage for Screening vs. Diagnostic Colonoscopies

If your doctor discovers an abnormality and your screening colonoscopy changes to diagnostic, you will be responsible for part of the cost. If you are on Original Medicare (Part A and Part B), you will be responsible for 20% of the remaining cost.

Medicare Part B outpatient coverage pays for colonoscopies. However, the Part B deductible does not apply to this procedure.

During a diagnostic colonoscopy, you may be responsible for the following out-of-pocket costs:

When a preventative colonoscopy changes to diagnostic, your physician will likely ask you to return for another colonoscopy before your ten-year time frame ends. In this case, the colonoscopy is diagnostic, and you will be responsible for the costs.

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Does Medicare Cover Colonoscopy Prep?

If your physician orders a colonoscopy prep kit, your Medicare Part D prescription drug plan will likely provide coverage. However, each Medicare Part D plan provides different coverage.

Thus, your plan may leave you responsible for a copayment or coinsurance when you receive the prep kit. Remember that Medicare prescription drug coverage is not part of Original Medicare. To receive this benefit, you must sign up for a policy through a private insurance company.

Do Medicare Advantage Plans Cover Colonoscopies?

If you have a Medicare Advantage plan, your policy must provide at least as much coverage as Original Medicare. In addition to screening colonoscopy coverage, many Medicare Advantage plans also cover diagnostic colonoscopy exams.

Several Medicare Advantage plans offer full coverage for a diagnostic colonoscopy and polyp removal. Thus, enrolling in a Medicare Advantage plan may be a good option if you are looking for full coverage for diagnostic and screening colonoscopies.

Do Medicare Supplement Plans Cover Colonoscopies?

If you enroll in a Medicare Supplement plan to pay secondary to your Original Medicare benefits, you will receive complete coverage for a screening colonoscopy. If the procedure becomes diagnostic, you may also receive full coverage, depending on your plan.

Your Medicare Supplement (Medigap) plan covers the 20% Medicare Part B coinsurance, and you will not have to pay anything out-of-pocket for your colonoscopy exam. This is because the Medicare Part B deductible does not apply to a diagnostic colonoscopy.

Medicare Colonoscopy Coverage FAQs

Does Medicare pay for colonoscopy anesthesia?
Yes. Original Medicare will cover the cost of anesthesia for a colonoscopy if you require the service.
Does Medicare cover a colonoscopy after age 75?
Yes. There is no age limit for Medicare coverage of a colonoscopy. Thus, Medicare will cover a colonoscopy at or after age 75.
How much does a colonoscopy cost with Medicare?
Original Medicare will fully cover a screening colonoscopy. If the screening colonoscopy becomes a diagnostic colonoscopy, Original Medicare will cover 80%. A Medigap plan can pick up the remaining 20%, leaving you with zero out-of-pocket costs for your colonoscopy.
Does Medicare cover colon polyp removal?
Medicare covers the removal of polyps from your colon. Depending on your additional coverage, you may be responsible for up to 20% of the cost of polyp removal.

How to Receive Medicare Coverage for a Colonoscopy

Now you know the answer to your original question – does Medicare cover a colonoscopy? – you may wonder how to receive additional benefits if you need a diagnostic exam. Fortunately, several options are available to help you cover the 20% Original Medicare leaves for you to pay out-of-pocket.

The most popular and least restrictive option is a Medigap plan. Call us at the number above to learn more about Medicare Supplement coverage and how it can benefit you.

A licensed Medicare agent will be more than happy to review your needs and help you decide which plan is best for you. Then, we will review all the top carriers in your area to help you receive the most comprehensive coverage possible from a top-rated carrier.

If you cannot call today, complete our complete our online rate form to learn more about how to receive help with the out-of-pocket costs Original Medicare leaves behind.

Sources

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David Haass

David Haass

David Haass is the Chief Technology Officer and Co-Founder of Elite Insurance Partners and MedicareFAQ.com. He is a member and regular contributor to Forbes Finance Council and stay up-to-date with the latest Medicare trends and changes. He holds a Bachelor of Science in Business Administration and Management from the University of Florida.

2 thoughts on "Medicare Coverage for Colonoscopy Screenings"

  1. I live on only $1511 per month after my Medicare A payment is deducted from my SS. My new doc ordered a bunch of tests, colonoscopy being one of them. I discovered the prep was going to cost me $180, and the copay $360, as I’ve previously had a polyp removed four years ago. I had to cancel. This is not what your article states. I have Humana Gold.

    1. Hi Ruth. Medicare Part A is premium-free if you’ve paid into Medicare for at least 10 years. Are you sure the premium coming out of your Social Security check is not for Part B? When you enroll in a Medicare Advantage plan, you leave Original Medicare. The Advantage carrier pays instead of Medicare. It’s up to the carrier how much they want to pay for each service. You’re more than likely paying at least 20% coinsurance on top of copays when you have a Medicare Advantage plan. I’m also wondering if your doctor is not in your plan’s network and that’s why you’re paying so much out of pocket. Advantage plans usually come with a very limited network of doctors. Did you confirm with your doctor that they accept your Advantage plan? If you’re looking for better coverage, you would need to enroll in a Medigap plan.

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