Medicare covers colonoscopies for individuals with Medicare. The time between covered colonoscopies varies depending on your risk of developing colorectal cancer.

A colonoscopy is a screening procedure where a doctor uses a very small camera to examine your lower intestines. This test lets your doctor check for cancer and for growths called polyps that may become cancer.

Yes, the Affordable Care Act requires Medicare and private insurers to cover the costs of colorectal screenings, including colonoscopies. A colonoscopy is an important health screening that can help prevent and treat colon cancers by removing polyps or precancerous growths.

Medicare will cover a colonoscopy once every 24 months for people who are at high risk of colorectal cancer and once every 120 months for people who are not at high risk. There is no age requirement.

The U.S. Preventive Services Task Force recommends that individuals have a colonoscopy beginning at age 50 years and continuing until they’re at least 75 years old. If you have a family history of colon cancer or other cancer risk factors, some doctors may recommend that you get one between the ages of 45 and 49 years old.

A colonoscopy is a medical procedure that involves using a thin, lighted tube with a camera on it to view the lining of the colon. A doctor performs a colonoscopy for different reasons:

  • Screening: A screening colonoscopy visualizes the colon and potentially removes precancerous growths called polyps. A person having a screening colonoscopy doesn’t have symptoms of intestinal problems.
  • Diagnostic: A diagnostic colonoscopy is performed when a person has intestinal symptoms and a doctor needs to examine the colon for irregularities.

Doctors typically perform these procedures using sedative medications to help a person relax or general anesthesia, which is when a person is asleep and unaware of the procedure.

Several factors go into how much a colonoscopy costs. These include:

  • Location: If a patient is healthy enough, they can usually have a colonoscopy at an outpatient surgery center. This is typically less expensive than a colonoscopy in a hospital setting.
  • Anesthesia type: If a patient selects general anesthesia over conscious sedation, the costs increase due to the need for an anesthesia provider.
  • Geographic area: Costs can vary by location in the country.
  • Tissue sampling: If a doctor takes tissue samples, they send them to a laboratory. This can increase the costs of equipment to sample the tissue and for a laboratory to evaluate it.

Colonoscopy costs with Medicare depend on whether the colonoscopy is being performed for screening or diagnostic purposes.

According to Medicare.gov, Medicare will pay for screening colonoscopies once every 24 months if a doctor considers you to be at high risk of colon cancer.

A doctor may determine you’re at high risk if you have a family history of colon cancer or you have a history of colon polyps or inflammatory bowel disease.

If you’re not at high risk of colon cancer, Medicare will pay for a colonoscopy once every 120 months, or 10 years. If you’ve previously had a flexible sigmoidoscopy, which doesn’t involve viewing the entire colon, Medicare may cover a colonoscopy once every 48 months, or 4 years.

Medicare may ask you to pay a portion of the bill if your doctor finds a polyp or takes other tissue samples during a colonoscopy. At that time, Medicare may ask you to pay:

  • 15% of the Medicare-approved amount for your doctor’s time
  • a copayment of 15% if you’re in a hospital setting

For this reason, it’s important to know what you may pay if you have a polyp or biopsy (tissue sample) removed during the procedure.

Also, the costs are different if the colonoscopy is for diagnostic purposes. For example, if you’re having digestive problems or signs of bleeding, a doctor may recommend a colonoscopy to diagnose the underlying cause.

Find an estimate of what you may pay for your colonoscopy

Medicare has a Procedure Price Lookup tool that helps you understand what you may expect to pay out of pocket for your colonoscopy.

You may also want to speak with your doctor’s office for specific information about what you may expect to pay out of pocket for your colonoscopy.

Medicare includes different parts that provide coverage for different types of medical services. This section describes how each part may or may not cover a colonoscopy.

Medicare Part A

Medicare Part A is the part of Medicare that covers hospital-related costs. If you require inpatient care in a hospital, Medicare Part A is the portion of insurance that pays for these costs.

Sometimes, you may find yourself in the hospital and require a colonoscopy. Say you experience a gastrointestinal (GI) bleed. Medicare Part A will pay for these services, and Medicare Part B (see below) will pay for your doctor’s services while you’re in the hospital.

Medicare may require you to pay a copay or deductible for services you receive in the hospital. This is usually one lump sum for up to 60 days of a hospital stay.

Medicare Part B

Medicare Part B is the portion of Medicare that pays for medical services and preventive care. This is the part that covers outpatient care, like a colonoscopy.

A person pays a monthly fee for Medicare Part B, and they have a deductible for the year. The deductible varies from year to year, but in 2024, it’s $240.

However, Medicare doesn’t require you to meet your deductible before it will pay for a colonoscopy, and it will pay regardless of whether the colonoscopy is for screening or diagnostic purposes.

Medicare Part C

Medicare Part C, or Medicare Advantage, is a Medicare plan that includes Part A, Part B, and some prescription drug coverage. As the Affordable Care Act mandates, a person’s Medicare Advantage plan must cover screening colonoscopies.

The major consideration if you have Medicare Part C is to ensure that the doctor and anesthesia providers are in-network for your plan since many Medicare Advantage plans require you to seek care with specified providers.

Medicare Part D

Medicare Part D is prescription drug coverage a person may purchase in addition to their other Medicare parts. Some Medicare Part D plans may cover prescriptions for bowel preparation to help clean out the colon before a colonoscopy.

Your Medicare Part D plan will explain which medications are covered and which are not.

Medicare supplement plans (Medigap)

Medicare supplement insurance helps cover out-of-pocket costs associated with healthcare. This includes costs like copayments and deductibles.

Your deductible doesn’t apply to a colonoscopy — Medicare Part B will pay for a screening colonoscopy regardless of whether you’ve met your deductible.

However, if you incur additional costs because a doctor removes polyps or tissue samples, some Medicare supplement insurance plans may help pay for these costs.

You’ll need to contact your insurance company before the colonoscopy to find out how much they may cover if you need polyp removal.

Ask your doctor’s office for an estimate of costs before you have a colonoscopy. The billing department can usually estimate an average cost based on Medicare and other private insurance you may have.

If, for any reason, your doctor’s office thinks Medicare won’t cover your colonoscopy costs, they’re required to give you a special notice called an Advance Beneficiary Notice of Noncoverage.

Another consideration is if you’ll receive anesthesia for the procedure. Anesthesia providers bill costs separately from the doctor performing the colonoscopy.

If you have insurance that requires an in-network doctor, you may also need to ask who’s providing the anesthesia to ensure that your costs are covered.

What other factors may affect how much you pay?

The main factor that affects how much you pay when you have Medicare is if your doctor removes a polyp or takes other tissue samples for laboratory review. Of course, you can’t predict if you have a polyp or not — that’s why the doctor is doing the screening in the first place.

For this reason, it’s best to ask your doctor’s office for an estimate of charges if you do have a polyp removed.

If your doctor’s office is unable to provide this estimate or you have further questions, you can also contact the U.S. Centers for Medicare & Medicaid Services by calling 800-MEDICARE (800-633-4227) or visiting Medicare.gov.

A colonoscopy is an important screening test that can detect signs of colorectal cancer.

Medicare covers the cost of the procedure for screening purposes, but if your doctor has to remove polyps, there are considerations, including anesthesia fees.

Talk with your doctor’s office to obtain an estimate of these costs so that you can anticipate them when scheduling.