Does Medicare cover colonoscopy?

Are colonoscopies covered by Medicare?

Colonoscopies are an essential part of preventative medicine for any senior. It’s common for people to wonder if Medicare will cover a colonoscopy. This article explains why colonoscopies are important for seniors to have and how they are covered under Original Medicare and Medicare Advantage.

Looking for live assistance with your Medicare coverage questions? Dial (800) 950-0608 to speak to an agent, or compare plans in your area online.

Screening for colon cancer is important for seniors.

30% of seniors aged 50 to 75 have never been screened for colon cancer. This type of cancer is the third most common across the United States.

Older adults are at higher risk for colon cancer compared to younger people. Risk factors for colon cancer include:

• Having a family history of colon cancer or colorectal polyps
• Being overweight
• Smoking
• Having a history of Crohn’s Disease
• Heavy alcohol use

Colonoscopies are an effective screening method for catching this type of cancer early. So, why have older adults hesitated in getting a colonoscopy? It may be due to a concern about Medicare covering the procedure. It is recommended that anyone over the age of 50 receive a colonoscopy as a part of a routine physical exam.

Any symptoms like abdominal pain, rectal bleeding, or unplanned weight loss may indicate that a non-routine colonoscopy is necessary.

Does Original Medicare cover colonoscopies?

Medicare generally covers 100% of the cost of colonoscopy if the doctor accepts the Medicare assignment and the beneficiary has the routine colonoscopy completed within a specified time frame. This means that the colonoscopy cost is nothing for the beneficiary. For those who are not determined to be at higher risk of colon cancer, a screening colonoscopy is covered every 10 years. 

Individuals are considered higher risk for colon cancer and are covered 100% for a colonoscopy every two years if they have:

• A history of colon cancer
• Had colon cancer or colorectal polyps
• Had inflammatory bowel disease

If a new or existing issue is found during the colonoscopy, the doctor may need to treat it or perform a diagnostic colonoscopy. If that is the case, the 20% Medicare-approved amount for the doctor’s service and a copayment may apply in a hospital setting. The deductible for Part B will not apply.

Do Medicare Advantage plans cover colonoscopies?

Medicare Advantage plans, which are offered by private insurers, must include the same coverage as Original Medicare. Plan providers must cover the cost of a colonoscopy if you see a provider in the plan network and meet the criteria listed above.

Additionally, many Medicare Advantage plans offer extra coverage benefits like dental and vision. Certain plans may even cover procedures related to colonoscopies more of the time or more comprehensively than Original Medicare. The type of coverage you revive can vary depending on the plan.

Browse Medicare Advantage options available in your area to get the benefits you need. Call (800) 950-0608 if you need live assistance!

Make the right choice for your coverage needs.

The main factors that influence whether or not a senior chooses Original Medicare or Medicare Advantage are coverage and cost. Making sure your health insurance covers all the care you know you’ll need, or that you’ll potentially need, is important.

Medicare Part B covers colonoscopies and other preventative procedures. But it’s not always easy to find the right type of Medicare coverage, and you may wish to make sure you’re covered for other types of care, including vision and dental. If you need help finding a plan that will fit your needs, call us at (800) 950-0608. We’ll be happy to help you find the right health insurance plan for you and your family.