Does Medicare Cover Colonoscopy Screenings?

Learn how Medicare covers colonoscopies

by Katie Banks+ on Mar 29, 2016 | 12 Comments

Colonoscopies test for colon cancer and other problems in the colon. This test can be expensive, and we get a lot of clients asking if this test is covered by Medicare. The answer is yes, and no. Let us explain.

Does Medicare Cover Colonoscopy Screenings?

Medicare covers colonoscopy screenings at no cost every 24 months for high risk patients, and 120 months for everyone else (in some cases every 48 months). This test is done at no cost to you, but if the test becomes diagnostic, takes a biopsy or removes a lesion, you will owe your 20% coinsurance, but you will not owe your Part B deductible.

Does Medigap Cover Colonscopy Screenings?

While Original Medicare picks up 100% of the colonoscopy screening, all Medigap plans pay all or part of your Part B coinsurance if you need further diagnostic treatment.

Learn More about Medigap Get a Medigap Quote

Does Medicare Advantage Cover Colonoscopy Screenings?

Yes, Medicare Advantage plans cover colonoscopy screenings, however if you need more diagnostic treatment, you will owe additional costs. Since each Medicare Advantage covers services differently, you will want to research how each Medicare Advantage covers the potential additional costs of a colonoscopy. 

Learn More about Medicare Advantage Get a MA Quote

Next steps

Go to our Medicare list of preventive screenings page to learn what other tests and screenings are covered. For questions about Medigap or Medicare Advantage call a licensed independent Senior65 insurance agent at 800-930-7956.

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Reader Comments and Questions

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By Rick on June 28, 2018

I turned 70 this March & recently lost coverage from my employer; I signed up for part a when I turned 65, signed up for B & D within 60 days of insurance ending. I did not realize I needed a “medigap” policy until today when I was scheduling my colonoscopy. Can I still purchase one? I am in excellent health.

Rick,
If you are within 6 months of your Medicare Part B effective date you can still enroll in a Medigap without any health questions required. You would be guarenteed to be approved regardless of your health condition.

If it has been more than 6 months, you could still apply but they could turn you down based on health question.

Please give us a call and we can help you enroll in a plan today at no additional cost. If you signed up today you Medigap coverage could begin on the first of next month. -Michelle from senior65.com


By Marietta on June 06, 2018

What's considered high risk? I have Part B does that cover Colonoscopy?

Marietta,
We do not have information on those specifics. Please check with your doctor on the criteria for high risk patients.
If you are considering additional coverage, please give us a call.
-Eric from Senior65.com


By wendie on April 07, 2018

Will medicare cover my colonoscopy? I have polyp history and was set up for a 3 yr screening from my last one. Which was in 2015. Am I covered? thank you

Wendie,
As the article above states, "Medicare covers colonoscopy screenings at no cost every 24 months for high risk patients, and 120 months for everyone else (in some cases every 48 months)."
Chick with your doctor if you fall under the high risk patient coverage by Medicare.
-Michelle from Senior65.com


By Philip on March 01, 2018

Hi: I had a colonoscopy four months ago and precancerous polyps were found and removed. My doctor wants to do another colonoscopy in two years. Will medicare pay for this? Thank you.

Philip,
As the article states above "Medicare covers colonoscopy screenings at no cost every 24 months for high risk patients, and 120 months for everyone else..." You need to confirm with your doctor if you are considered a high risk patient.
-Eric from Senior65.com


By Owen on January 15, 2018

I had a colonoscopy on April 27, 2016. Medicare covered the cost. It was recommended to have another in April of 2018. Medicare will cover the cost every 24 months. Is it necessary to wait until after April 27 for full coverage, or can I receive the colonoscopy in late May or early April, and still be covered?

Owen,
You will want to contact Medicare directly at 1-800-633-4227 to make sure you are covered for high risk screening (which is every 24 months) before proceeding. They can also confirm if you can have the procedure in early April or not.

While we help explain how Original Medicare works in tandem with supplemental insurance we are not confirm coverage of benefits.
-Michelle from Senior65


By Charlie on January 10, 2018

I had a colonoscopy 5 years ago and had 6 polips. Will Medicare pay for another colonoscopy that the doctor has ordered? I have plan N also.

Charlie
Medicare typically covers colonoscopy screening once every 48 months but their are exceptions. Please contact Medicare directly at 1-800-633-4227 to confirm how it would be covered in your case.
-Michelle at Senior65.com


By Linda on July 06, 2017

Just had my 10 year colonoscopy under original Medicare. Paid nothing to the doctor or the facility. BUT, although the procedure will not be done without anesthesia, Medicare required me to share that cost. Called them twice but they say NO preventive procedure can include anesthesia. So with no polyps, the full cost was for the prescription prep at $85 and the anesthesia at $32! I still don't understand their position on the anesthesia since their booklet states that for a test with no finding "you pay nothing"


By Sheila on June 16, 2017

Does Medicare cover a colonoscopy and endoscopy if done at the same time to diagnose blood in the stools?

Sheila,
Yes, Medicare will cover both, if your doctor and Medicare deem it medically necessary.
-Amy from https://www.senior65.com/


By Bob on June 15, 2017

I had a d diagnostic colonoscopy. I have Medigap plan F, and yet I have $185 balance applied to my deductible . I thought the deductible was covered by plan F. Am I wrong? Thank you

Bob,
You shouldn't have any out of pocket costs with Medigap F, as long as Original Medicare covers it. In your case, there is probably a service or treatment that Medicare doesn't cover; therefore, you're receiving a bill. You will want to contact Medicare directly for your specific question.
-Amy from https://www.senior65.com/


By Dominic Sartori on March 08, 2017

It has been only five years since my previous colonoscopy, but that one was before I had Medicare B coverage, so this will be my first under Medicare. Will it be covered? Thanks

Dominic,
Medicare covers a screening colonoscopy every 120 months (5 years), unless you're high risk, and in that case it's every 24 months, so you should be covered. However, we suggest contacting Original Medicare to confirm coverage before any procedure.
-Amy from https://www.senior65.com/


By Roger on March 31, 2016

I've never had a colonoscopy that didn't turn diagnostic. You should just say that you'll have to pay 20%. Will Medigap or Medicare Advantage cover more of my out of pocket costs?

Roger,
We hear you! Many colonoscopies end up being diagnostic, that's why we recommend getting a Medigap plan, because all plans cover part or all of your coinsurance. Please call one of our licensed independent insurance agents at 800-930-7956 to learn more about Medicare Supplement plans.
-Eric from https://www.senior65.com/


By Lillian on March 31, 2016

I was just told that I need to get a barium enema. Does Medicare cover that?

Lillian,
Medicare does cover screening barium enema, but there are costs left over for you (Part B deductible, copays, and coinsurance). To learn how to cover these costs through a Medigap plan, call one of our licensed independent insurance agents at 800-930-7956.
-Amy from https://www.senior65.com/



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