Medicare covers colonoscopy at no cost to you when it is done for screening — that is, to check for cancer or polyps before you have symptoms

Original Medicare (Part A and Part B) covers a screening colonoscopy once every 10 years if you are 50 or older and have no symptoms or family history of colorectal cancer. You pay nothing — no copay, no coinsurance, no deductible. Medicare pays the full cost when you go to a doctor or facility that accepts Medicare.

If your doctor finds and removes polyps during the procedure, Medicare still covers it as a screening visit with no cost to you. If the colonoscopy becomes a diagnostic procedure — meaning your doctor is investigating symptoms like bleeding or abdominal pain — the rules change slightly, and you may owe a copay depending on where the procedure happens.

Key Takeaways

  • Screening colonoscopy is covered at no cost once every 10 years for people 50 and older with no symptoms.
  • You must go to a provider who accepts Medicare for the coverage to explore.
  • If polyps are found and removed during a screening colonoscopy, you still pay nothing.
  • A colonoscopy done to investigate symptoms (like bleeding or pain) may require you to pay a copay or coinsurance.
  • Colonoscopy done before age 50 is not covered unless you have symptoms or a family history of colorectal cancer.

When Medicare covers the full cost with no copay

Medicare covers screening colonoscopy at 100 percent when all of these are true: you are 50 or older, you have no symptoms of colorectal disease, you have not had a colonoscopy in the past 10 years, and your doctor orders it as a screening procedure. The procedure can happen in a hospital outpatient department, an ambulatory surgery center, or a doctor's office — as long as the facility is Medicare-certified.

The no-cost coverage includes the procedure itself, the anesthesia used during the procedure, and the pathology work if tissue samples are taken. If your doctor removes polyps during the screening, that removal is included in the screening coverage and costs you nothing extra.

When you may owe money during or after colonoscopy

If your colonoscopy is diagnostic — ordered because you have symptoms like rectal bleeding, abdominal pain, or a change in bowel habits — Medicare covers it, but you may owe a copay. In a hospital outpatient setting, you typically pay a copay (the amount varies). In an ambulatory surgery center or doctor's office, you may owe 20 percent coinsurance after your Part B deductible is met.

You may also owe money if your doctor discovers something unexpected during a screening colonoscopy that requires additional treatment or a follow-up procedure scheduled for a different day. Ask your doctor before the procedure whether it is being ordered as screening or diagnostic, because that determines what you will owe.

How to make sure your colonoscopy is covered

Before you schedule, confirm that your doctor or facility accepts Medicare. You can search for Medicare-accepting providers on Medicare.gov or call your doctor's office directly and ask, "Do you accept Medicare, and will you bill Medicare for a screening colonoscopy?"

Tell your doctor that you want the procedure coded as a screening colonoscopy, not a diagnostic one, if you have no symptoms. Your doctor's office will submit the claim to Medicare after the procedure. You should receive an Explanation of Benefits (EOB) in the mail within a few weeks showing what Medicare paid and what you owe, if anything.

If you have a Medigap or Medicare Advantage plan in addition to Original Medicare, your supplemental coverage may explore depending on your plan. Contact your supplemental plan to understand what they cover for colonoscopy.

Colonoscopy before age 50 and special circumstances

If you are under 50, Medicare does not cover screening colonoscopy. However, if you have symptoms or a family history of colorectal cancer, your doctor may order a diagnostic colonoscopy, which Medicare will cover (with copay or coinsurance).

If you have had polyps removed in the past, your screening interval may be shorter than 10 years. Medicare will cover a colonoscopy sooner than 10 years if your doctor documents that it is medically necessary based on your previous results. Bring your prior colonoscopy report to your appointment so your doctor can note the interval.

What happens if you use a Medicare Advantage plan

Medicare Advantage plans (Part C) must cover screening colonoscopy at the same rate as Original Medicare — at no cost to you. However, the specific facilities and doctors covered may be limited to your plan's network. Before scheduling, check your plan's provider directory or call the plan to confirm your doctor is in-network.

Some Medicare Advantage plans may require prior authorization before the procedure. Call your plan's customer service number (on your insurance card) at least a week before your appointment to ask whether authorization is needed.

Frequently Asked Questions

Do I have to pay anything if my doctor finds and removes polyps during screening?

No. If the colonoscopy is ordered as screening and polyps are found and removed, the entire procedure remains covered at no cost to you. The removal is part of the screening service.

What if I had a colonoscopy less than 10 years ago — will Medicare cover another one?

Not as a screening procedure. Medicare covers screening colonoscopy once every 10 years. If your doctor orders one sooner, it will be coded as diagnostic, and you may owe a copay or coinsurance. The exception is if your prior results showed polyps or other findings that require earlier follow-up — your doctor can document medical necessity.

Will I owe anything if the facility bills me after Medicare pays?

You should not. Medicare-accepting facilities agree not to bill you for covered services beyond what Medicare pays. If you receive a bill, contact the facility's billing department and ask them to review the claim. You can also contact Medicare at 1-800-MEDICARE if the facility continues to bill you.

Does my Medigap plan cover the copay if the colonoscopy is diagnostic?

Most Medigap plans cover copays and coinsurance for Medicare-covered services, but the amount depends on your specific plan. Check your Medigap policy documents or call your Medigap insurer to confirm what they cover for colonoscopy.

What if my doctor's office says they do not accept Medicare?

You can still have the procedure done there, but you will likely pay the full cost out of pocket. Medicare will not reimburse you. Ask your doctor for a referral to a Medicare-accepting gastroenterologist or facility in your area.