{"id":57303,"date":"2023-02-24T19:01:28","date_gmt":"2023-02-25T00:01:28","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=57303"},"modified":"2026-03-17T15:36:54","modified_gmt":"2026-03-17T19:36:54","slug":"does-medicare-cover-colonoscopy","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/does-medicare-cover-colonoscopy\/","title":{"rendered":"Does Medicare cover colonoscopies?"},"content":{"rendered":"<p><span style=\"font-weight: 400;\">If you\u2019re at an age where you qualify for Medicare, that also means you\u2019re at an age where routine colonoscopies are an essential part of your healthcare check-ups. Colorectal cancer is the fourth <\/span><span style=\"font-weight: 400;\">most common<\/span><span style=\"font-weight: 400;\"> type in the United States, outside skin cancers. And with all kinds of cancer, early detection is key. If you\u2019re due for your next colonoscopy and have Medicare, let\u2019s find out if they cover the important screening. In addition to meeting certain risk requirements, you\u2019ll need Medicare Part B for coverage of colonoscopy screenings and anesthesia and Medicare Part D for coverage of colonoscopy prep kits.<\/span><\/p>\n<h2 id=\"medicare-coverage-for-colonoscopy\"><span style=\"font-weight: 400;\">Medicare coverage<\/span><span style=\"font-weight: 400;\"> for <\/span><span style=\"font-weight: 400;\">colonoscopy<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Does Medicare cover colonoscopy? Medicare\u2019s first rule for colonoscopy coverage is that you\u2019re older than 45.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">After that, your coverage for a colonoscopy depends on your risk factors. Those at high risk of colorectal cancer, such as those with a family history of colorectal cancer or colon cancer, are allowed more frequent screenings. This policy also applies to individuals with inflammatory bowel diseases like Crohn\u2019s disease or ulcerative colitis.\u00a0<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">If you\u2019re at <\/span><b>high risk<\/b><span style=\"font-weight: 400;\"> for colorectal cancer, Medicare pays for a colonoscopy every 24 months (two years).\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">If you\u2019ve had a previous flexible sigmoidoscopy or diagnostic test of the colon, then Medicare will pay for a colonoscopy every 48 months (four years).\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Medicare will pay for a colonoscopy every 120 months (10 years) if you&#8217;re not high-risk and at average risk.\u00a0<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Medicare pays for 100% of the routine screenings if your healthcare provider accepts Medicare assignment, <\/span><a href=\"https:\/\/www.medicare.gov\/coverage\/colonoscopies\"><span style=\"font-weight: 400;\">according to medicare.gov<\/span><\/a><span style=\"font-weight: 400;\">. However, if a polyp or other tissue is found and removed during the colonoscopy, you pay 15% of the Medicare-approved amount for the doctor\u2019s services. You\u2019ll also owe a 15% coinsurance amount in a hospital outpatient setting or ambulatory surgical center. The Part B deductible doesn\u2019t apply.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Medicare Part B covers the colonoscopy screenings and the drugs you\u2019ll need for the anesthesia. However, if your healthcare provider orders a <a href=\"https:\/\/www.singlecare.com\/prescription\/sutab\/what-is\">colonoscopy prep kit<\/a>, this is typically paid for by Medicare Part D, which is prescription drug coverage under Medicare.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">While <\/span><span style=\"font-weight: 400;\">computed tomographic (CT) colonography, or virtual colonoscopies, has become popular since the 2000s, the Centers for Medicare &amp; Medicaid Services do not cover these procedures as they state there is <\/span><a href=\"https:\/\/www.cms.gov\/medicare-coverage-database\/view\/ncacal-decision-memo.aspx?proposed=N&amp;NCAId=220\"><span style=\"font-weight: 400;\">inadequate evidence<\/span><\/a><span style=\"font-weight: 400;\"> to determine if it\u2019s an appropriate method of colorectal cancer screening.<\/span><\/p>\n<h2 id=\"coverage-for-screening-vs-diagnostic-colonoscopies\"><span style=\"font-weight: 400;\">Coverage for screening vs. <\/span><span style=\"font-weight: 400;\">diagnostic colonoscopies<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">A colonoscopy is a preventive screening, also called a preventive service, because it is a tool to prevent diseases and health problems. Medicare covers 100% of the cost of preventive care. That means you don\u2019t have to pay any coinsurance or copays toward the Part B deductible if your doctor accepts Medicare assignment<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u201cDuring routine colonoscopies, if polyps are found and removed, the procedure becomes a \u2018therapeutic\u2019 procedure, resulting in the beneficiary being responsible for a copay,\u201d explained Michelle Robbins, a licensed insurance agent in Corona, California, with<\/span> <a href=\"http:\/\/usinsuranceagents.com\/\"><span style=\"font-weight: 400;\">U.S. Insurance Agents<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">This means that if during your screening colonoscopy, your doctor finds something and needs to perform a biopsy on growths or remove a polyp, Medicare no longer considers this colonoscopy screening a preventive service. Instead, Medicare now considers it a diagnostic colonoscopy. While Medicare Part B still pays for this service, they no longer pay 100% of it. Now, they\u2019ll only cover 85% of the healthcare provider\u2019s services, and you\u2019ll need to pay a 15% copay of the Medicare-approved amount.<\/span><\/p>\n<h3 id=\"medicare-colonoscopy-loophole\"><span style=\"font-weight: 400;\">Medicare <\/span><span style=\"font-weight: 400;\">colonoscopy<\/span><span style=\"font-weight: 400;\"> loophole<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">In the above situation where you go in for a routine colonoscopy screening, and a polyp is removed, turning it into a diagnostic colonoscopy, you\u2019re now in the Medicare colonoscopy loophole because you\u2019re on the hook for paying for a procedure you thought was entirely covered. However, in 2020 <\/span><a href=\"https:\/\/fightcolorectalcancer.org\/blog\/medicare-loophole-passed\/\"><span style=\"font-weight: 400;\">a bill was passed<\/span><\/a><span style=\"font-weight: 400;\"> to stop these unexpected out-of-pocket costs that will be in full effect in 2030.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\t\t<div class=\"singlecare-dynamic-newsletter-wrapper sin-newsletter-wrapper\">\n\t\t\t<span class=\"heading\">Get our wellness newsletter<\/span>\n\t\t\t<form class=\"form-wrapper\" data-newsletter-form=\"1\" data-subsource=\"Wellness Newsletter\">\n\t\t\t\t<div class=\"input-wrapper\">\n\t\t\t\t\t<label for=\"dynamic-email\">Email<\/label>\n\t\t\t\t\t<input type=\"email\" id=\"dynamic-email\" class=\"email\" required>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"input-wrapper\">\n\t\t\t\t\t<input class=\"submit-form-btn\" type=\"submit\" value=\"Click to sign up\">\n\t\t\t\t<\/div>\n\t\t\t<\/form>\n\t\t\t<p class=\"success-message\" aria-live=\"polite\"><\/p>\n\t\t<\/div>\n\t<\/span><\/p>\n<h2 id=\"what-is-the-cost-of-a-colonoscopy-with-medicare\"><span style=\"font-weight: 400;\">What is the <\/span><span style=\"font-weight: 400;\">cost of a colonoscopy<\/span><span style=\"font-weight: 400;\"> with Medicare?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">\u201cUsually, there is no cost for colonoscopies,\u201d said Robbins. \u201cThe procedure classification could change if a polyp or tissue is taken during the screening. If it\u2019s within a hospital setting, a beneficiary may have to pay a copay of\u00a0 15% of the physician\u2019s services.\u201d<\/span><\/p>\n<p><span style=\"font-weight: 400;\">A routine colonoscopy screening test will be free to a Medicare beneficiary unless an unforeseen polyp or growth is found during the procedure. Then you\u2019ll need to pay for 15% of the procedure bill unless you have Medicare Supplement Insurance or a Medigap plan that helps cover copays and coinsurance not covered by Medicare.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">You\u2019ll also need a colonoscopy preparation kit to empty your bowels before having the procedure. Most Medicare Part D insurance plans will cover the cost of colonoscopy prep kits, but there may be a copay or coinsurance.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The most commonly prescribed colonoscopy prep kit is the <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/suprep-bowel-prep-kit\"><span style=\"font-weight: 400;\">SUPREP Bowel Prep Kit<\/span><\/a><span style=\"font-weight: 400;\">. According to <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/na-sulfate-k-sulfate-mg-sulf#Price-History\"><span style=\"font-weight: 400;\">SingleCare<\/span><\/a><span style=\"font-weight: 400;\">, the average cash price for this generic prep kit is $185 for two bottles.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">No matter how old you get, Medicare will continue to pay for colonoscopies as long as you are older than 45 and follow the allowed time frame. <\/span><\/p>\n<h2 id=\"how-to-save-on-a-colonoscopy-with-medicare\"><span style=\"font-weight: 400;\">How to save on a <\/span><span style=\"font-weight: 400;\">colonoscopy<\/span><span style=\"font-weight: 400;\"> with Medicare<\/span><\/h2>\n<h3 id=\"medicaid\"><span style=\"font-weight: 400;\">Medicaid<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">If you\u2019re low-income, you may qualify for your state\u2019s <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/what-is-medicaid\/\"><span style=\"font-weight: 400;\">Medicaid program<\/span><\/a><span style=\"font-weight: 400;\">. Medicaid will help cover the costs left over from a diagnostic colonoscopy if you need a polyp removed during your screening. You can see if you qualify for <\/span><a href=\"https:\/\/www.medicaid.gov\/\"><span style=\"font-weight: 400;\">Medicaid here<\/span><\/a><span style=\"font-weight: 400;\">.\u00a0<\/span><\/p>\n<h3 id=\"extra-help\"><span style=\"font-weight: 400;\">Extra Help<\/span><\/h3>\n<p><a href=\"https:\/\/www.singlecare.com\/blog\/medicare-extra-help\/\"><span style=\"font-weight: 400;\">Extra Help<\/span><\/a><span style=\"font-weight: 400;\"> is another option for seniors living on a limited income. Extra Help gives financial help to those struggling with costs not covered by a Medicare Part D prescription drug plan, which could help pay for a bowel prep kit. You can see if you qualify <\/span><a href=\"https:\/\/www.ssa.gov\/benefits\/medicare\/prescriptionhelp.html\"><span style=\"font-weight: 400;\">here<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/p>\n<h3 id=\"medigap-plans\"><span style=\"font-weight: 400;\">Medigap<\/span><span style=\"font-weight: 400;\"> Plans<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">You can fill in the gaps that Original Medicare doesn\u2019t cover with a <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/what-is-medigap\/\"><span style=\"font-weight: 400;\">Medigap plan<\/span><\/a><span style=\"font-weight: 400;\"> (Medicare supplement insurance). These plans help cover the costs of copays, coinsurance, and deductibles.<\/span><\/p>\n<h3 id=\"medicare-advantage-plans\"><span style=\"font-weight: 400;\">Medicare Advantage Plans<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Instead of using Original Medicare with Medicare Part A and Medicare Part B, you can use a Part C or <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/what-is-medicare-advantage\/\"><span style=\"font-weight: 400;\">Medicare Advantage Plan<\/span><\/a><span style=\"font-weight: 400;\">. These are offered by private health insurance companies and used in place of Original Medicare. Each state has different plans, but some may have better deals on prescription drugs and colonoscopy services that you can switch to during the enrollment period.<\/span><\/p>\n<h3 id=\"singlecare\"><span style=\"font-weight: 400;\">SingleCare<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">If you need help covering prescription drug costs, you should look at SingleCare, which offers coupons for thousands of medications. The <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/na-sulfate-k-sulfate-mg-sulf\"><span style=\"font-weight: 400;\">generic Suprep Bowel Prep Kit<\/span><\/a><span style=\"font-weight: 400;\"> runs at a cash price of $185 for two bottles, but you could get up to 80% off with a free SingleCare coupon.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>If you\u2019re at an age where you qualify for Medicare, that also means you\u2019re at an age where routine colonoscopies are an essential part of your healthcare check-ups. Colorectal cancer is the fourth most common type in the United States, outside skin cancers. And with all kinds of cancer, early detection is key. If you\u2019re [&hellip;]<\/p>\n","protected":false},"author":133,"featured_media":57304,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[2],"tags":[15],"coauthors":[15090],"class_list":["post-57303","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-company","tag-medicare","wpautop"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.4 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Are colonoscopies covered by Medicare?<\/title>\n<meta name=\"description\" content=\"Medicare Part B covers colonoscopy screenings and the meds needed for anesthesia. 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Medicare Part D typically covers a colonoscopy prep kit if ordered.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.singlecare.com\/blog\/does-medicare-cover-colonoscopy\/\" \/>\n<meta property=\"og:site_name\" content=\"The Checkup\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/singlecare\" \/>\n<meta property=\"article:published_time\" content=\"2023-02-25T00:01:28+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2026-03-17T19:36:54+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.singlecare.com\/blog\/wp-content\/uploads\/2023\/02\/does-medicare-cover-colonoscopy.png\" \/>\n\t<meta property=\"og:image:width\" content=\"1920\" \/>\n\t<meta property=\"og:image:height\" content=\"1080\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/png\" \/>\n<meta name=\"author\" content=\"Rebecca Rovenstine\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@SingleCare\" \/>\n<meta name=\"twitter:site\" content=\"@SingleCare\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Rebecca Rovenstine\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"5 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/www.singlecare.com\\\/blog\\\/does-medicare-cover-colonoscopy\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.singlecare.com\\\/blog\\\/does-medicare-cover-colonoscopy\\\/\"},\"author\":{\"name\":\"Christie Falzone\",\"@id\":\"https:\\\/\\\/www.singlecare.com\\\/blog\\\/#\\\/schema\\\/person\\\/5ff7c7bb5ce0c66a6962ecf7c8d7941e\"},\"headline\":\"Does Medicare cover colonoscopies?\",\"datePublished\":\"2023-02-25T00:01:28+00:00\",\"dateModified\":\"2026-03-17T19:36:54+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/www.singlecare.com\\\/blog\\\/does-medicare-cover-colonoscopy\\\/\"},\"wordCount\":1114,\"publisher\":{\"@id\":\"https:\\\/\\\/www.singlecare.com\\\/blog\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/www.singlecare.com\\\/blog\\\/does-medicare-cover-colonoscopy\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/www.singlecare.com\\\/blog\\\/wp-content\\\/uploads\\\/2023\\\/02\\\/does-medicare-cover-colonoscopy.png\",\"keywords\":[\"Medicare\"],\"articleSection\":[\"Company\"],\"inLanguage\":\"en-US\"},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/www.singlecare.com\\\/blog\\\/does-medicare-cover-colonoscopy\\\/\",\"url\":\"https:\\\/\\\/www.singlecare.com\\\/blog\\\/does-medicare-cover-colonoscopy\\\/\",\"name\":\"Are colonoscopies covered by Medicare?\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.singlecare.com\\\/blog\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/www.singlecare.com\\\/blog\\\/does-medicare-cover-colonoscopy\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/www.singlecare.com\\\/blog\\\/does-medicare-cover-colonoscopy\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/www.singlecare.com\\\/blog\\\/wp-content\\\/uploads\\\/2023\\\/02\\\/does-medicare-cover-colonoscopy.png\",\"datePublished\":\"2023-02-25T00:01:28+00:00\",\"dateModified\":\"2026-03-17T19:36:54+00:00\",\"description\":\"Medicare Part B covers colonoscopy screenings and the meds needed for anesthesia. 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