Does Medicare Cover Colonoscopy? Learn How Medicare Covers a Colonoscopy and Provides Colorectal Cancer Screening Test
With more and more people living longer, colonoscopies are becoming a necessity to detect cancer early.
But what happens when you have Medicare? Is the procedure covered by your insurance carrier?
This is important information for those who are at risk of colorectal cancer and need this test done on a regular basis and as part of your preventive services.
Here’s our guide:
Table of Contents
What are Colonoscopy Screening Tests?
A colonoscopy cancer screening test is a medical procedure that is used to screen for or diagnose illness or find precancerous growths. A colonoscopy is done under general anesthesia and the person is asleep.
A colonoscopy is a medical procedure that involves inserting a long, flexible tube into the rectum and large intestine in order to examine the inside of the bowel. The procedure can be used to screen for or diagnose various conditions, such as colorectal cancer, Crohn’s disease, and ulcerative colitis.
It can also be used to remove precancerous growths (polyps) from the bowel lining.
Colonoscopies are generally safe and have a low risk of complications. However, as with any medical procedure, there are some risks involved. These include bleeding, perforation (tearing) of the bowel wall, and infection.
Medicare Coverage for Colonoscopy Screenings
Medicare coverage for colonoscopy screenings is very important for people over the age of 50. This preventative measure can help to detect any early signs of colorectal cancer, which is one of the leading causes of death in America.
Many private insurance companies also offer coverage for this potentially life-saving procedure.
Aside from screening colonoscopy coverage, many Medicare Advantage plans and Medigap plans pay for diagnostic colonoscopy exams.
If you are at risk for developing colorectal cancer your doctor may recommend more frequent testing. Most Medicare Beneficiaries receive a colonoscopy once every 10 years.
What are the Different Types of Colonoscopy Procedures Covered by Medicare Part B?
Diagnostic colonoscopy
A diagnostic colonoscopy is a procedure used to diagnose conditions such as colon cancer. The procedure may involve biopsies, lesion removals, and more. This type of colonoscopy can be beneficial because it can help catch colon cancer early when it is most treatable.
Colorectal Cancer Screenings
A colonoscopy is a medical procedure used to screen for colorectal cancer. The test involves inserting a long, flexible tube into the rectum and colon in order to examine the lining of these organs.
A colonoscopy can help to detect precancerous growths (polyps) or early-stage cancers. If polyps are found, they can often be removed during the same procedure.
Therapeutic colonoscopy
A therapeutic colonoscopy is a medical procedure that involves inserting a thin, lighted tube with a camera on it into the colon. The purpose of this procedure is to treat conditions such as polyps or other growths in the colon.
Therapeutic colonoscopies can also be used to remove blockages in the colon or to take biopsies of suspicious areas.
Therapeutic colonoscopy has a number of benefits which include
- The ability to treat conditions without surgery,
- Reduced risks associated with anesthesia,
- Shorter recovery times.
In some cases, a therapeutic colonoscopy may be the only treatment option available.
Proctosigmoidoscopy
Proctosigmoidoscopy is a test that removes abnormal cells or growths from the sigmoid colon. It is less invasive than a colonoscopy and does not require sedation.
How Does Medicare Insurance Coverage for Colorectal Cancer Work?
Medicare insurance coverage for colorectal cancer usually includes a combination of preventive screenings, surgeries, and treatments. Most preventive screenings, such as colonoscopies, are covered 100%.
Other screenings, such as sigmoidoscopies and stool tests, are typically covered at 80% so Medicare Beneficiaries would be required to pay 20 percent without a Medigap plan or Medicare Advantage plan.
If you are diagnosed with colorectal cancer, Medicare will cover most of the costs associated with your treatment, including surgeries, chemotherapy, and radiation therapy.
Medicare Advantage Plans: Health Insurance Coverage
Those covered by a Medicare Advantage Plan will incur costs up to their max out-of-pocket. This will include copays, deductibles, and coinsurance. Most Medicare Advantage plans include a 20 percent coinsurance for cancer-fighting drugs. Max out-of-pocket costs for 2023 Medicare Advantage plans are allowed to go up to $8,300.
Medicare Beneficiaries will be required to stay within their plan’s network of doctors and medical facilities to qualify for Medicare benefits for colorectal cancer treatment.
Medicare Supplement Plan F and Plan G:
With a Medigap plan F, your plan will cover 100% of the cost of your colorectal cancer treatment. Those enrolled in a Medigap Plan G will be responsible for their annual Part B deductible is not already satisfied. Once the Part B deductible has been met, all cancer treatments are 100% covered by your Plan.
Medicare Part D Prescription Drug Coverage:
Medicare Beneficiaries will need a strong Part D prescription drug coverage plan to will cost the high cost of medications. Medicare Advantage plans offer Part D coverage in most plans.
Colorectal cancer is treated through an outpatient medical facility in most instances which means Part B will cover the cancer treatment. Medical services may be required in a hospital depending on the needs of the patent.
Does Medicare Cover Colorectal Cancer Screening?
Yes, Medicare does cover colorectal cancer screening. This includes screenings such as colonoscopies and stool tests. Medicare will also cover any related procedures, such as biopsies or the removal of polyps.
Do Medicare Plans Cover Both Cancer Screening Tests and Diagnostic Colonoscopies?
Medicare covers screening colonoscopies at 100%. A diagnostic colonoscopy is a different type of test.
Medicare covers diagnostic colonoscopies at a discounted rate. You will have to pay the remaining cost of the procedure, but there is no deductible.
How much does Medicare Pay for a Colonoscopy?
Medicare will cover the cost of your colonoscopy screening if it is a preventive measure. Medicare Medicare Part B covers colonoscopy screenings. The screening is a preventive measure and is covered by Medicare.
During a colonoscopy, if your doctor finds and removes a polyp or other tissue, you will pay 15% of the Medicare-Approved Amount for your doctor’s services under Original Medicare.
Many Medicare Advantage plans also may include a deductible or copay if your doctor removes any tissue or polyps during the colonoscopy.
Medicare Beneficiaries enrolled in a Medigap Plan F are covered at 100 percent even if a polyp is removed, while Medigap Plan G will cover 100% of the cost after you have met your annual Part B deductible.
What are the best Medicare Advantage Plan Options to Cover Colonoscopy Costs?
The best Medicare Advantage plans for colonoscopies are those that cover the procedure in full and provide additional benefits to help with the cost of care. Medicare Advantage plans can provide comprehensive coverage.
Each Medicare Advantage insurance company offers a variety of Medicare insurance plans each offering a different level of coverage.
Medicare Beneficiaries may have to pay more for one plan while another Medicare Advantage plan can offer more comprehensive benefits with limited out-of-pocket costs.
When looking for a Medicare Advantage plan it is vital to work with a Medicare Advantage Insurance Agent to help you navigate the process. They will ensure not only the medical benefits covered but also your doctor’s and your Medicare Part D prescription drug costs.
How Do Medicare Advantage Plans Cover Diagnostic Colonoscopies?
Medicare Advantage plans are required to cover preventive screenings, including diagnostic colonoscopies.
This means that if your doctor recommends a colonoscopy to check for signs of cancer, your Medicare Advantage plan will likely cover the cost of the procedure.
However, you may still be responsible for some out-of-pocket costs, such as copay and coinsurance.
How Do Medicare Supplement Plans F, Plan G, and Plan N Cover Colonoscopies?
How does Plan F cover colonoscopies?
Medigap Plan F will cover 100 percent of the cost not covered by Original Medicare. Prior to January 1, 2020, Plan F was the most comprehensive Medicare Supplement plan available to people 65 or older.
Medicare Beneficiaries covered by Medigap Plan F would pay zero dollars for any Medicare-approved procedure and doctor visits.
How does Plan G cover colonoscopies?
Medicare Supplement Plan G covers 100% of the Medicare Part B coinsurance and copayment for this procedure. This means that you would only be responsible for your annual Medicare Part B deductible ($226 in 2023), and Medigap Plan G would pay the rest.
If you had already paid your annual Part B deductible, your costs would be zero even if the doctor had to remove a polyp.
How does Plan N cover colonoscopies?
Plan N is a type of Medicare supplement insurance that can help cover some of the costs associated with a colonoscopy. Medicare Beneficiaries enrolled in Medigap Plan N are responsible for the annual Part B deductible, doctor copays, ER copays, and 15 percent of the costs for doctors who do not accept Medicare assignment.
What other tests does Medicare cover for colon cancer?
Medicare covers three types of alternative cancer screening tests. The FOBT is the most commonly covered test. There is variation in coverage by test type and age group. Medicare only pays for the Cologuard brand of DNA test.
The blood-based DNA test is also known as a liquid biopsy and is covered every three years for patients aged 50-85. The multitarget stool DNA (sDNA) test is covered every three years for people aged 50-85.
What is the Medicare Colonoscopy Loophole?
The Medicare colonoscopy loophole is a law that was passed in 2020 that protects Medicare patients who get a screening colonoscopy that turns into a diagnostic procedure.
If your routine colonoscopy screening detects medical issues, your test is no longer considered screening and is no longer free.
The Removing Barriers to Colorectal Cancer Screening Act gradually reduces Medicare patients’ coinsurance and eliminate out-of-pocket costs completely by 2030.
If you’re billed for a colonoscopy screening, you may want to contact your provider or Medicare to be sure you are charged the correct amount.
How Much Does a Colonoscopy Cost?
The cost of a colonoscopy can vary depending on several factors, such as the doctor’s fees, the hospital’s fees, and whether or not insurance will cover the procedure.
In general, a colonoscopy can cost anywhere from $1,700 to $5,000. The average cost of a colonoscopy is $3,000
Does Medicare Part B Cover Colon Cancer Screenings?
Yes, Medicare Part B does cover colon cancer screenings. This preventative measure is important for those over the age of 50, as it can help catch cancer early and improve treatment options.
Colonoscopy Screening Frequently Asked Questions
Who should get screened for colon cancer?
The American Cancer Society (ACS) recommends starting screening at age 45 for people at average risk. People at high risk for colorectal cancer may need to start screening before age 45.
People at higher risk for colorectal cancer include those who have a family history of the disease, those who have had radiation therapy to the abdomen or pelvis, and those who have a personal history of colorectal cancer or certain types of polyps. If you think you’re at risk for colorectal cancer, talk to your healthcare provider.
The best way to screen for cancer is through a colonoscopy. A colonoscopy is the best screening option for cancer because it allows your doctor to directly visualize your entire colon and remove any precancerous polyps that may be present.
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What are the Benefits of a Colonoscopy?
There are a number of benefits to regular colonoscopies including
- A colonoscopy can help doctors diagnose and treat colorectal cancer.
- Colonoscopies are an important way to prevent colorectal cancer.
- Colonoscopies can help doctors detect and treat polyps early, which can save lives.
- Adults should start colon cancer screenings at 50 years old and continue screenings until 75.
- A colonoscopy can be used for different purposes, such as diagnosing GI symptoms or screening for cancer.
- Colonoscopies can be used to diagnose and monitor a range of health issues.
Will Original Medicare pay for a Colonoscopy After age 70?
Medicare will cover colonoscopies after age 70, with no age restrictions for coverage.
How Do I Prepare for having a Colonoscopy?
If you are about to go in for a colonoscopy your doctor will provide you with instructions.
- Follow the doctor’s instructions carefully the day before the procedure.
- Lie on your side during the procedure to reduce pain and discomfort.
- Drink plenty of fluids and avoid eating or drinking anything after midnight the night before the procedure.
- Avoid strenuous activity or movement for several hours afterward (you may feel tired).
Your medical doctor may have additional or different requirements for you to follow. These are general guidelines for how to prepare for a colonoscopy.
When should I get screened for colon cancer?
The standard recommendation is to start colonoscopies at age 50. However, if you have multiple risk factors or a family history of colon cancer, your doctor may recommend starting earlier. Other screening options include a stool test every one to three years starting at age 50, or a CT colonography every five years starting at age 50.
Talk to your doctor about which screening option is right for you based on your individual risk factors. Catching colon cancer early can save your life.
How often should I get screened for colon cancer?
If you are 50 years of age or older, you should have a colonoscopy every 10 years. If you have a family history of colon cancer or other risk factors, your doctor may recommend getting a colonoscopy more often.
What are the risks of colonoscopy screening?
Most of the risks for colonoscopy screening are low. They may include:
- There is a small risk of bleeding after the procedure.
- There is a small risk of infection after the procedure.
- There is a small risk of perforation (a hole in the colon) after the procedure.
- There is a small risk of anesthesia complications after the procedure.
What can I expect during and after a colonoscopy screening?
A colonoscopy is a screening test that helps your doctor detect cancer. The procedure usually takes around 30-60 minutes. During the procedure, you will lie on your side while the doctor inserts a long, flexible tube into your rectum and colon.
The tube has a small camera attached to it, which allows the doctor to see inside your colon.
After the procedure, you will pass gas to clear the air that was blown into your colon during the procedure. It is also normal to have mild cramps or a little blood in your first stool after the procedure.
Overall, most people feel back to normal within a day or two after having a colonoscopy screening.
Our Medicare Agents are Here to Help Find Medicare Coverage for Screening For Colon Cancer
If you’re 50 years or older, you should start getting screened for colorectal cancer.
Medicare Part B covers your colonoscopy screenings, as part of your preventive health coverage. However, you may have some out-of-pocket costs.
We recommend also purchasing a cancer policy prior to turning 65. Cancer policies cover additional expenses not included in your health insurance coverage.
You may have to pay a deductible, coinsurance, and copayments. To help lower your costs, ask your doctor if they accept assignment.
Call and talk with one of our independent Medicare insurance agents to discuss which Medicare plan is best for you. Our tools will compare Medicare Supplement plans and Medicare Advantage plans in your area that covers colonoscopies.
Integrity Now Insurance Brokers is a full-service Medicare insurance Agency with dozens of Medicare insurance companies that we work with.
You can fill out our online form or call us at 562-735-3553.
