Does Medicare Cover Colorectal Cancer Screening?

Yes, Medicare covers colorectal cancer screening. If you are 45 or older, Medicare Part B covers several types of screening tests to help find precancerous polyps or cancer early, when treatment is most effective. For most of these preventive screenings, you pay nothing as long as your doctor or health care provider accepts assignment.

Colorectal cancer is a serious risk, but it is also highly preventable with regular screening. Medicare recognizes this and provides solid coverage for the tests you need. The specific tests covered and how often you can get them depend on your age and your level of risk for colorectal cancer.

Medicare covers several different screening methods. The most common include screening colonoscopies, fecal occult blood tests (FOBT), multi-target sDNA tests (like Cologuard), and barium enemas.

For a screening colonoscopy, Medicare covers the procedure once every 120 months (10 years) if you are not at high risk, or once every 24 months (2 years) if you are at high risk. If you have had a flexible sigmoidoscopy, Medicare will cover a screening colonoscopy 48 months after that test. You pay nothing for the screening colonoscopy if your doctor accepts assignment. However, if a polyp or other tissue is found and removed during the screening, the procedure is then considered diagnostic, and you may have to pay a 20% coinsurance and the Part B deductible.

Fecal occult blood tests are covered once every 12 months if you are 45 or older. You pay nothing for this test if your doctor accepts assignment. Multi-target sDNA tests are covered once every 3 years for people aged 45 to 85 who show no symptoms of colorectal disease and are at average risk. Again, you pay nothing for this test if your provider accepts assignment.

Barium enemas are covered once every 48 months if you are 45 or older and not at high risk, or once every 24 months if you are at high risk. For this test, you pay 20% of the Medicare-approved amount, and the Part B deductible applies. If the test is done in a hospital outpatient setting, you also pay a copayment.

When it comes to your health, you need straight answers, no surprises. The system can be confusing, but understanding your coverage shouldn't be a full-time job. You've paid into Medicare your whole working life; now it's time to make sure it works for you. Protect what you've earned by knowing exactly what tests are covered and when.

It is important to understand how your Medicare choices affect your coverage for these screenings. The Medicare module reminds us that there are two paths, not two products: Traditional Medicare (Parts A and B) and Medicare Advantage (Part C).

If you choose the Traditional Medicare path, your Part B covers these preventive screenings as described above. Because Traditional Medicare has gaps - like the 20% coinsurance if a polyp is removed during a colonoscopy - many people choose to add a Medicare Supplement (Medigap) plan. A Medigap plan fills the gaps by law, paying the coinsurance and copayments that Traditional Medicare leaves behind.

If you choose the Medicare Advantage path, your plan must cover all the preventive services that Original Medicare covers, including colorectal cancer screenings. However, you must follow the plan's rules, which usually means using doctors and facilities in the plan's network. If you go out of network, you may have to pay more, or the screening might not be covered at all.

Before you schedule any screening, it is always a good idea to talk to your doctor about which test is right for you and to verify your coverage. If you have a Medicare Advantage plan, check with your plan to make sure your provider is in-network.

Don't leave your health or your finances to chance. We are on your side of the table, ready to walk you through every option. Whether you are deciding between Traditional Medicare and Medicare Advantage, or looking for the right Medigap plan to cover the gaps, we can help. Compare free, no obligation.