Medicare covers colonoscopy at no cost to you when it is used for screening in people without symptoms

Medicare Part B pays for a screening colonoscopy once every 10 years if you are 50 or older and have no signs of colorectal cancer. You pay nothing — no copay, no coinsurance, no deductible. This applies whether you have Original Medicare or a Medicare Advantage plan, though Advantage plans must cover it at the same level.

If your doctor finds and removes a polyp during the screening, Medicare still covers the full procedure at no cost to you. The removal counts as treatment of a finding, not a separate service. However, if your doctor discovers something that requires follow-up — such as a polyp that needs closer examination or removal at a later visit — that follow-up procedure may have different cost rules depending on what is found and when it happens.

If you have symptoms like bleeding, pain, or changes in bowel habits, your doctor may order a diagnostic colonoscopy instead of a screening one. Diagnostic colonoscopy follows different payment rules and may involve cost-sharing on your part.

Key Takeaways

  • Screening colonoscopy is covered at no cost once every 10 years for people 50 and older with no symptoms.
  • Polyp removal during a screening colonoscopy is covered as part of the screening and costs you nothing.
  • A colonoscopy ordered because of symptoms (diagnostic colonoscopy) may require you to pay a copay or coinsurance.
  • Both Original Medicare and Medicare Advantage plans must cover screening colonoscopy with no out-of-pocket cost.
  • Your doctor's office should verify your coverage before the procedure to confirm whether it is classified as screening or diagnostic.

The difference between screening and diagnostic colonoscopy

A screening colonoscopy is performed on people with no symptoms to look for cancer or precancerous growths. Medicare covers this with zero cost-sharing. If your doctor removes a polyp during screening, that removal is included in the screening benefit and costs you nothing.

A diagnostic colonoscopy is ordered when you have symptoms — such as rectal bleeding, persistent abdominal pain, chronic diarrhea, or a positive result on another screening test. For diagnostic colonoscopy, you typically pay a copay (usually $20 to $50) or coinsurance (usually 20% of the Medicare-approved amount) after you meet your Part B deductible. The exact amount depends on your specific plan and whether you have Original Medicare or Medicare Advantage.

The classification matters because it determines your cost. If your doctor orders a colonoscopy because of symptoms but the procedure turns out to be normal, Medicare still classifies it as diagnostic, and you still owe cost-sharing. Ask your doctor's office before the procedure whether it will be billed as screening or diagnostic.

What happens if a polyp is found and removed

If your doctor finds a polyp during a screening colonoscopy and removes it, Medicare covers the removal as part of the screening benefit. You pay nothing extra. This is true even if the polyp is large, requires special removal techniques, or is sent to a lab for analysis.

However, if the polyp is complex or the doctor cannot remove it completely during the screening visit, you may need a follow-up procedure. That follow-up procedure is typically classified as diagnostic (because it is addressing a known finding) and may involve cost-sharing on your part. Your doctor should tell you before the follow-up visit whether you will owe money.

If a polyp is found and removed, your doctor will recommend when your next colonoscopy should be — often 5 to 10 years later depending on what was found. That future screening colonoscopy will also be covered at no cost when it is due.

Coverage for colonoscopy with symptoms or abnormal results

If you have symptoms like rectal bleeding, persistent abdominal pain, or changes in bowel habits, your doctor may order a colonoscopy to find the cause. This is diagnostic colonoscopy, and Medicare covers it but with cost-sharing. You will owe a copay or coinsurance after your Part B deductible is met.

If you had a positive result on a non-invasive screening test — such as a positive fecal immunochemical test (FIT) or a positive stool DNA test — a follow-up colonoscopy is also classified as diagnostic. You will owe cost-sharing for this procedure as well.

Some Medicare Advantage plans offer additional benefits and may cover diagnostic colonoscopy with lower or no cost-sharing. Check your plan documents or call your plan's customer service to learn what you will owe for a diagnostic procedure.

How to confirm your coverage before the procedure

Before your colonoscopy, contact your doctor's office and ask them to verify whether the procedure will be billed as screening or diagnostic. Provide them with your Medicare card. The office staff should be able to tell you whether you will owe any money and how much.

If you have Original Medicare, you can also call Medicare directly at 1-800-MEDICARE (1-800-633-4227) to confirm coverage. Have your Medicare number ready. If you have a Medicare Advantage plan, call the customer service number on your insurance card.

Ask your doctor's office about the facility where the procedure will take place. Colonoscopies performed in a hospital outpatient department may have different cost-sharing than those in an ambulatory surgery center or office-based endoscopy suite. Medicare covers the procedure in all these settings, but your out-of-pocket cost may vary.

What to ask your doctor before scheduling

Before you schedule a colonoscopy, ask your doctor these questions:

  • Is this a screening colonoscopy or a diagnostic colonoscopy?
  • If it is diagnostic, what symptoms or test results are making it necessary?
  • When should my next screening colonoscopy be scheduled?
  • Where will the procedure take place, and will the facility bill Medicare directly?
  • If a polyp is found and needs to be removed, is that removal included in the screening benefit or will it cost me extra?
  • If a follow-up procedure is needed, what will that cost me?

Frequently Asked Questions

Do I have to pay anything for a screening colonoscopy?

No. Medicare covers screening colonoscopy at no cost to you when you are 50 or older and have no symptoms. You pay no copay, deductible, or coinsurance. This includes the cost of polyp removal if one is found during the screening.

What if I have symptoms — will Medicare still cover my colonoscopy?

Yes, Medicare covers diagnostic colonoscopy when you have symptoms, but you will owe cost-sharing. You typically pay a copay or 20% coinsurance after meeting your Part B deductible. The exact amount depends on your plan. Call your doctor's office to find out what you will owe.

How often does Medicare pay for screening colonoscopy?

Medicare covers screening colonoscopy once every 10 years for people 50 and older with no symptoms. If a polyp is removed, your doctor may recommend a sooner follow-up, which would be classified as diagnostic and involve cost-sharing.

Will I owe money if the doctor finds something during my screening colonoscopy?

No. If a polyp or other finding is removed during a screening colonoscopy, that removal is covered as part of the screening benefit and costs you nothing. However, if a follow-up procedure is needed weeks or months later to address the finding, that follow-up may be classified as diagnostic and involve cost-sharing.

What is the difference between my copay for screening versus diagnostic colonoscopy?

Screening colonoscopy costs you nothing. Diagnostic colonoscopy typically costs a copay (usually $20 to $50) or 20% coinsurance after your Part B deductible. The exact amount depends on your plan and the facility. Ask your doctor's office to verify the cost before your procedure.