Does Medicare Cover a Colonoscopy?
Last Updated : 09/10/20184 min read
According to the National Institute of Health’s National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), a colonoscopy is often used as a screening tool for colon cancer and colon polyps. If you are enrolled in Original Medicare (Part A and Part B), Part B will pay for this test once every 10 years.
If you are at high risk for colorectal cancer, Medicare covers this test once every 24 months. If your doctor participates with Medicare, you generally pay nothing for a screening colonoscopy.
Why do doctors order colonoscopy?
According to the National Institutes of Health’s National Cancer Institute, colorectal cancer is the 4th most common type of cancer in the United States after breast, lung, and prostate cancer. About 135,000 new cases of colon and rectal cancer are diagnosed each year.
The NIDDK notes that doctors recommend colorectal cancer screening with colonoscopy at age 50 if you are generally healthy and have no unusual risk factors for colorectal cancer.
If you have unexplained symptoms which may suggest colorectal cancer, such as changes in bowel habits, weight loss, abdominal pain, or bleeding from the anus, your doctor may order a colonoscopy at any age to check for signs of the disease, according to NIDDK.
How is colonoscopy performed?
According to NIDDK, the National Institute of Diabetes and Digestive and Kidney Diseases, a colonoscopy is performed in a hospital or outpatient facility. You will be given medication, such as sedatives or anesthesia, in an IV to keep you comfortable during the procedure. Your doctor uses a camera called a colonoscope to take images of your large intestine. If he finds any polyps during the study, he may remove them and send them to the lab for testing. Your doctor may also take a biopsy during the procedure. Colonoscopy generally takes between 30 and 60 minutes.
It’s important to note that if your doctor does perform a biopsy or remove a polyp during colonoscopy, Medicare considers it a diagnostic procedure and you may owe a copayment or coinsurance amount for the service. Your Medicare Part B deductible, however, will not apply.
After the procedure, you’ll rest at the hospital or outpatient department for an hour or two before you can go home. A friend or family member will need to drive you home. Be sure to follow your doctor’s instructions on how to care for yourself after the procedure. Most people can return to normal activities the day after a colonoscopy, according to NIDDK.
If your doctor removed any polyps or took a biopsy during the procedure, the lab will have results within a few days.
Does Medicare cover any other colon cancer tests?
Depending on your health, symptoms, and other risk factors, your doctor may order other colorectal cancer screening tests such as:
- Flexible sigmoidoscopy.
- Barium enema.
- Fecal occult blood test.
- Multi-target stool DNA test.
If you are age 50 or over, Medicare will pay for these screening studies, although you may have to pay Medicare Part B deductible, copays and coinsurance amounts, depending on the test.
If you are at high risk for colorectal cancer and concerned about your health care costs, a Medicare Advantage plan (Part C) may help you better manage your out-of-pocket costs. Medicare Advantage plans are offered by private companies approved by Medicare, and while they are required to provide the same coverage as Original Medicare (except for hospice care, which is still covered by Part A), they can and often do offer additional benefits such as Part D coverage for prescription drugs and coverage for routine vision, dental, and even hearing care.
Keep in mind that not all plan types and benefits may be available in every location. You will also need to continue paying your Medicare Part B premiums plus any premiums required by your plan.
Need more information about Medicare and colonoscopy?
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