Medicare Coverage for Cologuard

Medicare Part B covers Cologuard (a stool-based DNA test for colorectal cancer screening) at no cost to you if you meet the age and risk requirements. The test itself is free, and Medicare pays the lab directly. You do not pay a copay, coinsurance, or deductible for the screening itself.

However, coverage depends on three things: your age, your risk level for colorectal cancer, and whether your doctor orders the test as a screening (not a diagnostic test). If any of those conditions are not met, Medicare will not cover it, and you will owe the full cost — typically $400 to $600 out of pocket.

Key Takeaways

  • Medicare Part B covers Cologuard screening at no cost if you are between 50 and 85 years old and at average risk for colorectal cancer.
  • Your doctor must order the test as a screening test, not as a diagnostic test to investigate symptoms or abnormal results.
  • If you have a personal or family history of colorectal cancer or polyps, you may not meet the "average risk" requirement and should ask your doctor whether Cologuard is the right choice for you.
  • Medicare covers the test once every three years if results are normal; if results are abnormal, you will need a colonoscopy, which Medicare also covers.
  • If your doctor orders it as a diagnostic test or you are outside the age range, you pay the full lab cost yourself.

Who Medicare Covers and Who It Does Not

Medicare covers Cologuard screening for people aged 50 to 85 who are at average risk for colorectal cancer. Average risk means you have no personal history of colorectal cancer, polyps, or inflammatory bowel disease, and no family history of colorectal cancer in a first-degree relative (parent, sibling, or child).

If you are under 50 or over 85, Medicare does not cover Cologuard, even if your doctor recommends it. If you have any of the risk factors listed above, you do not meet the average-risk definition, and Medicare will not pay. In those cases, talk to your doctor about whether Cologuard is still appropriate for you — it may be, but you would pay out of pocket.

People with a family history of colorectal cancer diagnosed before age 50, or with two or more relatives with colorectal cancer at any age, are considered higher risk and typically need colonoscopy screening instead, which Medicare also covers at no cost.

Screening vs. Diagnostic: Why the Difference Matters

Medicare distinguishes between a screening test (checking for disease in someone with no symptoms) and a diagnostic test (investigating symptoms or abnormal results). Cologuard is covered only as a screening test.

If you have symptoms like blood in stool, persistent diarrhea, or unexplained weight loss, your doctor will order Cologuard as a diagnostic test, not a screening test. In that case, Medicare will not cover it under the screening benefit, and you will owe the cost. The same applies if you have had an abnormal result on another screening test (like a colonoscopy or fecal immunochemical test) and your doctor orders Cologuard to follow up — that is diagnostic, not screening.

Before your doctor orders the test, ask whether it is being ordered as a screening or diagnostic test. If it is diagnostic, ask about your other options and what you will owe.

How to Get Cologuard Covered by Medicare

The process is straightforward if you meet the requirements. Your doctor orders the test through the lab (usually Exact Sciences, the company that makes Cologuard). The lab contacts Medicare to confirm coverage, sends you a collection kit at home, and you return the sample by mail. The lab then bills Medicare directly.

You should receive the kit within a few days of your doctor's order. No appointment is needed — you collect the sample at home. Results typically come back within one to two weeks. If the result is normal, you do not need further screening for three years (unless your doctor recommends otherwise based on your health history).

If the result is abnormal, your doctor will recommend a colonoscopy to look inside your colon. Medicare covers colonoscopy screening at no cost, and it is often done by the same gastroenterologist or hospital where your primary care doctor refers you.

What Happens If Results Are Abnormal

An abnormal Cologuard result does not mean you have cancer — it means the test detected DNA changes that warrant further investigation. Your doctor will refer you for a colonoscopy, which allows a specialist to see your colon directly and remove any polyps or take biopsies if needed.

Medicare covers the colonoscopy at no cost if it is performed as a follow-up to an abnormal screening test. You do not pay for the procedure, anesthesia, or pathology if polyps are removed and tested. If the colonoscopy finds and removes polyps, your doctor will tell you when to return for your next screening — usually in 3 to 10 years depending on what was found.

Costs You Might Still Owe

If you meet all the coverage requirements, the Cologuard screening itself is free. However, you may owe money in these situations: if you are outside the age range (under 50 or over 85); if you do not meet the average-risk definition; if your doctor orders it as a diagnostic test rather than screening; or if you have not met your Part B deductible for the year (though the screening itself does not count toward the deductible).

If you are unsure whether you meet the requirements, call Medicare at 1-800-MEDICARE before your doctor orders the test. You can also ask your doctor's office to check your coverage before the order is placed. Some labs will also verify coverage for you when your doctor sends the order.

Alternatives to Cologuard If Medicare Does Not Cover It

If you do not meet Medicare's coverage rules for Cologuard, other screening options may still be covered. Colonoscopy is covered at no cost for average-risk people aged 50 to 75 (and sometimes older, depending on your health). Fecal immunochemical test (FIT) and high-sensitivity guaiac-based fecal occult blood test (gFOBT) are also covered annually at no cost.

If you are at higher risk due to family history or personal history, your doctor may recommend colonoscopy as your primary screening method, which Medicare covers. Talk to your doctor about which screening method is right for your age, risk level, and preferences.

Frequently Asked Questions

Can I get Cologuard if I am 86 years old?

No. Medicare covers Cologuard screening only for people aged 50 to 85. If you are 86 or older, Medicare will not pay for it. Talk to your doctor about whether other screening methods are appropriate for you at your age.

What if my doctor says I need Cologuard because of my family history?

If you have a family history of colorectal cancer, you do not meet Medicare's "average risk" definition, and Medicare will not cover Cologuard under the screening benefit. Your doctor may still recommend it, but you would pay the full cost. Ask your doctor whether colonoscopy (which Medicare covers) is a better option for you.

Do I have to do Cologuard, or can I choose colonoscopy instead?

You can choose. Medicare covers both Cologuard and colonoscopy for average-risk people aged 50 to 75. Talk to your doctor about which fits your preferences and health situation. Colonoscopy is more invasive but can remove polyps during the same procedure; Cologuard is non-invasive but requires a colonoscopy if results are abnormal.

Will I owe anything if my Cologuard result is abnormal and I need a colonoscopy?

No. The colonoscopy is covered at no cost as a follow-up to an abnormal screening test. You do not pay for the procedure, anesthesia, or removal of polyps found during the exam.

What if I had Cologuard done before I turned 50 — will Medicare cover it now that I am 50?

Yes. Medicare coverage begins at age 50. If you had Cologuard done before age 50 (and paid out of pocket), Medicare will cover it going forward once you turn 50, assuming you meet the other requirements. Your doctor can order a new test, and Medicare will pay.