Does Medicare Cover a Colonoscopy?

According to the World Health Organization (WHO), colon cancer is one of the most common cancers around. In fact, in 2020 there were about 1.93 million cases around the world. This makes colon cancer the third most common cancer (behind lung cancer and breast cancer).

Colon and rectum cancer was also the 2nd most common cause of death by cancer in 2020. This horrible disease took the lives of around 935,000 people.

One way to detect colon cancer is through a colonoscopy. A colonoscopy is a health screening that can help prevent and treat colon cancer through the removal of polyps or precancerous growths.

So a common question many people have is, “Does Medicare cover a colonoscopy?” In this article, we answer that question in clear, plain English. You will also find the average costs of a colonoscopy and other helpful info.

Does Medicare Cover a Colonoscopy?

The short answer is yes; Medicare will cover the cost of a colonoscopy. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your colonoscopy. Below we look at what these are so you know what to expect.

Original Medicare Colonoscopy Coverage

Original Medicare (Medicare Part A and Part B) provides coverage for a colonoscopy. Medicare Part A provides coverage for a colonoscopy if you need the screening as part of an inpatient stay.

In this case, even though Medicare Part A covers the service, coverage for your doctor’s fee falls under Medicare Part B.

If you get a colonoscopy in an outpatient setting, Medicare Part B covers it.

Medicare will provide coverage for your colonoscopy once every 2 years. But this is only if your healthcare provider considers that you are at a high risk of developing colon cancer.

If you previously have had a flexible sigmoidoscopy, Medicare may provide coverage once every 4 years.

If you are not at high risk of developing colon cancer, Medicare will provide coverage for a colonoscopy once every 120 months or 10 years.

Medicare may ask you for a copayment if your healthcare provider finds a polyp or takes other tissue samples during a colonoscopy. Medicare will require you to pay 20 percent of the Medicare-approved amount for your healthcare provider’s time.

Part C Coverage

Medicare Advantage plans (Medicare Part C) also provide coverage for a colonoscopy. They cover everything Original Medicare covers, as well as offer some additional benefits. However, exactly what they cover and how much the out-of-pocket costs are will vary depending on the specifics of your plan.

Medicare Part C Coverage

Some Medicare Part D plans may provide coverage for prescription medications for bowel preparation to help clean out the colon before a colonoscopy.

How Much Does A Colonoscopy Cost?

The cost of a colonoscopy will typically range from $2,000 to $3,750. The average cost in the US for those without insurance is $3,080.

There are several factors that may affect the cost of a colonoscopy. Some of them are:

The location
The type of anesthesia you get
Tissue sampling

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.