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Dear Connie,
I know that a colonoscopy is good for detecting colon cancer. And with a family history, I plan on being proactive in its prevention and detection. I’m wondering if Medicare considers a colonoscopy preventative, and does Medicare cover a colonoscopy in Texas?
Dedicated to cancer prevention,
Joseph from Plano, Texas
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Local, licensed insurance agents with 25+ years of experienceDear Joseph,
We’re pleased that you’re being thoughtful about the prevention and detection of colon cancer. Although colon cancer is the second leading cause of cancer death in the United States, a colonoscopy makes colorectal cancer one of the few preventable cancers.
It’s important to note that for women 70 and older, colon cancer is the second most common cancer and the fourth most common for men 70 and older. This is why it’s so critical that you begin screening and are consistent.
A colonoscopy is considered a preventative screening.
In addition to screening for polyps, colonoscopies can detect inflammatory bowel diseases (IBD), Crohn’s, and ulcerative colitis.
Because of this, Original Medicare Part B pays the total cost of a colonoscopy screening. If your doctor or other health care provider accepts assignment, you won’t need to pay any deductible, coinsurance, or copayments. This means that the provider accepts Medicare’s payment in full.
Medicare covers screening colonoscopies once every two years (24 months) if you’re at high risk for colorectal cancer. It sounds like you have a family history, so you may fall within this category.
Medicare considers those with the following personal or family history at high risk of colon cancer:
Agent tip:
“A Medicare Advantage plan provides free colonoscopy screenings as frequently as Original Medicare, plus many cover the costs of diagnostic colonoscopies and polyp removal free of charge.“
If you are considered not high-risk, Medicare covers the test every ten years or every four years after a flexible sigmoidoscopy.
If during your colonoscopy, your doctor finds and removes a polyp or other tissue while you’re under anesthesia, the procedure is no longer a screening colonoscopy. Now, it’s a diagnostic colonoscopy.
At that point, Medicare pays 80% of the cost, but you may have to pay 20% of the Medicare-approved amount. In an outpatient hospital, you also pay the hospital 20% coinsurance. But you would not need to pay the Medicare Part B deductible, which is $257 in 2025.
Free, unbiased serviceCompare all major plans and carriers Local, licensed insurance agents with 25+ years of experienceStarting in 2023, changes began to the percentage of coinsurance owed should a preventative colonoscopy or flexible sigmoidoscopy screening transform into a diagnostic procedure while you’re under anesthesia.
If you have a Medicare Advantage plan, they provide free colonoscopy screenings as frequently as Original Medicare. Plus, many Medicare Advantage plans cover the costs of diagnostic colonoscopies and polyp removal free of charge. That’s something you won’t get from Original Medicare – until 2030.
And that’s one less thing to worry about as you go under anesthesia.
If you want to keep your Original Medicare but want to protect yourself from high out-of-pocket costs, you should consider a Medicare Supplement plan (Medigap).
I hope this information was helpful and clarified your question on whether Medicare covers colonoscopies in Texas. We hope you’ll find the care you need and that we can help. If you’re looking for a hospital with superior cancer care or services, we can locate a Medicare plan to serve you there.
Curious if Medicare covers the at-home colon cancer test, Cologuard? We’ve also responded to that question: Does Medicare cover Cologuard?
At Connie Health, we help you throughout your Medicare journey. For additional coverage questions, contact a local licensed Connie Health agent at (623) 223-8884 (TTY: 711) for help.
Yes, Original Medicare and Medicare Advantage plans pay for screening colonoscopies because they are preventative. The only requirement is that your doctor or healthcare provider accepts Medicare assignment. If they do, then you won’t pay the Part B deductible or any coinsurance or copayments.
Original Medicare and Medicare Advantage plans pay for a screening colonoscopy once every 10 years if you are not considered high-risk. If you have a family history and are high-risk, then Medicare would cover a screening colonoscopy once every 24 months.
Yes. There is no age requirement to receive Medicare coverage for a colonoscopy. Medicare will cover your colonoscopy after age 75.
Cancer.gov recommends that people aged 76 to 85 consider overall health, prior screening history, and preferences in deciding whether screening is appropriate. There are risks involved with colonoscopy, such as bleeding and perforation of the colon, and also risks involved with the preparation, especially in older people.
Colonoscopies are usually a preventative procedure. If you’ve had a positive Cologuard test, a colonoscopy afterward is now a diagnostic service. Because of this, you will owe coinsurance with the service.
The coinsurance percentage is changing. You can expect to pay these percentages between 2024 and 2030 – and beyond.
Colonoscopies are considered preventative screening; therefore, Original Medicare Part B pays the total cost of a colonoscopy screening. You should owe $0 if your healthcare provider accepts the assignment.
If your doctor or other health care provider accepts the assignment, you won’t need to pay any deductible, coinsurance, or copayments. This means that the provider accepts Medicare’s payment in full.
If, during your colonoscopy, your doctor finds and removes a polyp or other tissue while you’re under anesthesia, the procedure is no longer a screening colonoscopy. Now, it’s a diagnostic colonoscopy.
The cost depends on where the colonoscopy takes place. According to Medicare.gov, at an ambulatory surgical center, the national average is $765. At a hospital outpatient department, the national average is $1,228. At that point, Medicare pays 85% of the cost, but you may have to pay 15% of the Medicare-approved amount.
You could pay $152 or $256 for a colonoscopy through stoma; with the removal of tumor(s), polyp(s), or another lesion(s) by snare technique.
This includes facility and doctor fees. You may need more than one doctor, and additional costs may apply.
A Medicare Advantage plan provides free colonoscopy screenings as frequently as Original Medicare, plus many cover the costs of diagnostic colonoscopies and polyp removal free of charge.
There is no age at which Medicare stops paying for a colonoscopy.
Cancer.gov recommends that for people 76 to 85, clinicians should consider the patient’s overall health, prior screening history, and preferences in deciding whether screening is appropriate. There are risks involved with colonoscopy, such as bleeding and perforation of the colon, and also risks involved with the preparation, especially in older people.
Medicare covers screening colonoscopies once every two years (24 months) if you’re at high risk for colorectal cancer.
Medicare covers the test every ten or four years after a flexible sigmoidoscopy.
A Medicare Advantage plan provides free colonoscopy screenings as frequently as Original Medicare, plus many cover the costs of diagnostic colonoscopies and polyp removal free of charge.
Read more by Richard Torres
I am a Spanish-speaking Texas Life and Health Insurance Licensed Agent and have been helping people with Medicare since 2016. I am a U.S. Army Veteran and served under Operation Enduring Freedom. I enjoy spending time with my family and coaching youth soccer and basketball.
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