Coffee & Coverage: Does Medicare Cover Colonoscopies?

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If you have Medicare, your coverage will pay for a preventive colonoscopy. However, how often you can have the procedure covered depends if you qualify.

What is a colonoscopy?

A colonoscopy is an outpatient procedure where a doctor examines the large intestines by inserting a thin, flexible scope into the rectum. The scope has a light at the end of it so as the scope advances through the colon, the doctor can get images of the lining and any unusual growths.

Medicare coverage

If you are considered high risk for colorectal cancer, your Medicare will cover the full cost of a colonoscopy once every two years. If you are not considered high risk, Medicare will cover the costs of screening once every 10 years or four years after a flexible sigmoidoscopy. A flexible sigmoidoscopy is similar to a colonoscopy but does not probe the entire colon.

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Original Medicare will pay the full cost of a colonoscopy if a medical provider who accepts Medicare rates does the procedure. However, if a polyp is found and removed during the colonoscopy, the procedure is considered diagnostic rather than preventive. In that case, you will likely be responsible for 20 percent of the Medicare-approved amount.   

The Medicare Part B deductible does not apply to colonoscopies. Medicare will pay whether or not you have met your annual deductible. If your doctor recommends you have a colonoscopy more often than Medicare normally covers, you may be responsible for paying some or all of the cost.

According to the Centers for Medicare & Medicaid Services (CMS), someone who meets at least one of the following qualifications may qualify for more frequent colonoscopies:

  • Personal history of colorectal cancer; adenomatous polyps, or an inflammatory bowel disease
  • Close relatives such as parents, siblings, or children that have had colorectal cancer or an adenomatous polyp
  • Family history of inherited syndromes linked to colorectal cancer

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