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Does Medicare Cover Colon Cancer Screening?

 

When does Medicare cover colon cancer screening? Learn about six colorectal cancer screenings.

David Minaya
April 17, 2023

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Colorectal cancer is the third leading cause  of cancer-related deaths in the U.S. — but greater access to life-saving screenings and other preventative measures have led to a drop in the death rate over the past several decades. The American Cancer Society (ACS)  recommends people at average risk of colorectal cancer get their first screening at 45 and every year thereafter through age 75. After that, ACS recommends discussing with your doctor to determine the right course of action for you. Medicare provides coverage for several colorectal cancer screenings, including a new test for 2022. Let’s talk about your options.

Medicare Does Cover Colon Cancer Screenings

Medicare does cover six specific  colon cancer screenings, including:
\ Fecal occult blood test — Once every 12 months for people 50+
\ Flexible sigmoidoscopy — Once every 48 months for high risk individuals 50+, or once every 10 years after a colonoscopy if you’re not high risk
\ Colonoscopy — Once every 24 months if you’re high risk, or once every 10 years if you’re not high risk (but not within 48 months of a flexible sigmoidoscopy)
\ Barium enema — Once every 24 months for high risk individuals 50+, or once every 48 months if you’re not high risk (but not within 48 months of a flexible sigmoidoscopy)
\ Multi-target stool DNA tests — Once every three years if you’re 50-85, have no colorectal disease symptoms and aren’t high risk
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Blood-based biomarker tests — New in 2022 , this test is available once every three years if you’re 50-85, have no colorectal disease symptoms and aren’t high risk
Medicare covers 100% on all of the above screenings, except barium enemas. Original Medicare can cover 80% of barium enemas.

Am I at High Risk for Colorectal Cancer?

With all this talk of cancer screenings, you may be wondering if you’re considered high risk.

The ACS suggests  people at higher risk of developing colorectal cancer start screenings before age 45 and continue with more frequent screenings. You may be high risk if you have:

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A family or personal history of colorectal cancer or certain kinds of polyps
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A personal history of inflammatory bowel disease, like Crohn’s or ulcerative colitis
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A family history of a hereditary colorectal cancer syndrome
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A personal history of treating prior cancer with radiation to the abdomen

Discuss your colorectal cancer screening options with your doctor to help decide which tests are appropriate for you.

Colorectal Screening Costs

In 2023, you only pay 15% coinsurance for the Medicare-approved amount when your doctor finds and removes a polyp or other tissue during a colonoscopy or flexible sigmoidoscopy. Also, the Medicare Part B deductible does not apply. This biopsy is 5% less than the typical 20% coinsurance cost.

Learn more about Medicare-covered cancer screenings.

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LEGAL DISCLAIMER: The above is meant to be strictly educational and not intended to provide medical advice or solicit the sales of an insurance product or service of any kind.

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