Does Medicare Cover Colorectal Cancer Treatments?

Victoria Burke by Victoria Burke | Licensed since 2011
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This article was updated on: 09/10/2018

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Colorectal cancer is a cancer that begins in the colon or the rectum. If you or a loved are diagnosed with colorectal cancer, the good news is that colorectal cancer treatment may have a good probability of extending your life. According to American Cancer Society, the 5-year relative survival rate for people with stage 1 colon cancer is about 92%. For people with Stage 2 and Stage 3 colon cancer, the 5-year relative survival rate is up to 89%. The first step of colorectal cancer treatment is detecting the disease.

What are the screening tests for colorectal cancer?

Many cases of colorectal cancer begin as small noncancerous growths called polyps, according to the NIH – in some cases, the polyps become cancerous, possibly with no outward symptoms. For this reason, U.S. Preventive Service Task Force recommends that adults age 50 to 75 be screened for colorectal cancer.

Some screening tests your doctor might order for you (depending on your situation), according to the NIH, may include:

  • Colonoscopy – a thin, flexible tube with a small viewing lens, or camera, is moved through your colon. A small tool on the tube can be used to remove tissue or polyps for analysis. This is done once every 10 years, according to the Centers for Disease Control and Prevention (CDC).
  • Sigmoidoscopy – a thin, flexible tube similar to the one used for colonoscopy is moved through your lower colon only, not the entire large intestine. This is done once every 5 to 10 years, according to the CDC.
  • Stool tests – after you collect a stool sample, a lab checks it for the presence of blood. This could be done once every one to three years depending on the test, according to the CDC.
  • High-sensitivity fecal occult blood test – there are a couple of tests that fall into this category; they are additional methods of analyzing a stool sample for the presence of blood.
  • Virtual colonoscopy – this method may appeal to some people because the scan is done from outside the body. However, the NIH reports that this method is still being studied, and technicians cannot collect tissue samples or remove polyps with it.

How is colorectal cancer treated?

As with all cancers, your colorectal cancer treatment will depend on factors such as the location, size, and stage of the cancer, and whether or not it has spread to other areas of the body. Your treatment could range from minimally invasive surgery to remove cancerous lesions to removal of all or part of the colon and adjacent lymph nodes. Your doctor may recommend chemotherapy, radiation therapy, and/or prescription drug therapy, according to the American Cancer Society.

How does Medicare cover colorectal cancer?

Under Original Medicare (Part A and Part B), any allowable charges related to colorectal cancer treatment you receive as an inpatient in the hospital are covered under your Part A hospital insurance portion. Doctor visits and outpatient colorectal cancer treatments are usually covered under your Part B benefits. Part A and Part B each have deductible amounts you may have to pay before Medicare covers your treatment.

However, Medicare Part B may cover colorectal cancer screening at no cost to you if certain risk categories apply to you.

Are you an Original Medicare beneficiary concerned with managing your Medicare expenses such as copayments, coinsurance, and deductibles? Medigap (Medicare Supplement) plans are offered by private insurance companies and can help you pay your out-of-pocket costs for services covered under Original Medicare.

Medicare Advantage (Medicare Part C) gives you another option for receiving Medicare benefits for colorectal cancer treatment. Medicare Advantage plans cover everything Original Medicare covers (except hospice care, which is still covered under Medicare Part A), but often include other benefits such as prescription drug coverage and routine vision and dental care. If you sign up for a Medicare Advantage plan, you’re still in the Medicare program and need to continue paying your Part B premium, along with any premium the plan may charge.

If you need help understanding your Medicare coverage and how it pays for colorectal cancer treatment, I am happy to answer your questions. You can schedule a phone call with me or request an email with personalized information just for you – simply click one of the buttons below. Click on the “View profile” button to learn more about me. You can also see Medicare plans that may be available in your area by clicking on the “Compare Plans” button.

Colorectal Cancer,” National Institutes of Health – U.S. National Library of Medicare, August 2015

Colorectal Cancer,” American Cancer Society, March 2016

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