Find Out If Medicare Will Cover Your Colonoscopy

Taking preventive measures with your health becomes more important with age, especially for something as important as detecting cancer, which is why Medicare makes sure your colonoscopy is covered.
Lewis Mark
Published on
January 1, 2024
Updated on
May 16, 2024

Are you experiencing pains in your abdomen? Have you noticed some changes in your regular bowel movements that make you feel uneasy? You may need to head to the doctor immediately and learn if you’ll need a colonoscopy, a procedure believed to be the most accurate test to determine the presence of cancer in the rectum or colon. Ideally, detecting it early helps save lives. Let us look deeper into detail about colon screening exam.

What Is A Colonoscopy?

It is an examination targeted at detecting changes, flaws, or abnormalities in the large intestines or colon and rectum. These abnormalities deter with the normal functioning of the digestive tract.

Why do doctors order colonoscopy?

You are likely to be a candidate for the exam if you check in the hospital with abdominal pains, chronic constipation, and diarrhea and rectal bleeding that remains persistent despite taking drugs to ease the symptoms. It is a more accurate affirming test to the reasons why you might be suffering from abdominal conditions. Doctors use the test as a cancer screening tool for colon polyps and cancer, especially when you have no signs of the disease but stand high chances to contract cancer.

How is a colonoscopy performed?

First, you are assigned a gastroenterologist; the examiner placed to perform the test takes about 30 minutes to an hour’s time to complete the exam. You will be induced with anesthetics in your veins to help you feel relaxed and partially sleepy to make the examination period painless and comfortable.

The examiner will then ask you to lie on your left side. The position allows the doctor to insert a long, flexible tube-like instrument into the anus and then gently advanced to the rectum and colon. The tip of the tube is attached to a camera and a source of light that aids with visual control all the way from the rectum to the first part of the colon, medically referred to as the cecum.

The tube’s flexibility allows it to bend so that the examiner can move around the curves without damaging the walls of the colon. Occasionally, the doctor will help you change position to enable smooth movement of the scope. The instrument also blows in the air into the colon for expansion which ideally helps the examiner move the tube smoothly as well as sees clearly.

If the examiner spots anything abnormal during the test, a few samples of the flawed tissues are usually extracted for biopsy. In some cases, where polyps and abnormal growths are spotted, they are removed surgically, but that is not part of the colon screening description. The exam primarily targets at diagnosing the growth conditions accurately.

Will Medicare Cover Your Colonoscopy?

Now that we have covered all there is to the actual test, and you are sure you need to check in with your doctor for testing, the next question probably ringing in your mind is whether or not your colonoscopy is covered by Medicare, so let’s dive in.

Medicare covers all colon screening examinations every two years at no cost for patients who stand at high risk of having colon complications. However, for anyone else who doesn’t qualify in that gap, Medicare covers the expense every ten years, or in some special cases, four years.

It should be noted that Medicare draws the line clearly that the actual test is not payable, but if the test turns diagnostic and the examiner changes the tune to collect samples for a biopsy or extracts a growth, you will personally be eligible to pay 20% coinsurance.

If you are enrolled in Original Medicare, you are fully covered for the cancer screening. It means that the insurance pays all of Medicare Part B coinsurance if the test veers into the diagnostic way. Medicare Advantage plans cover for colon screening, but you may need to pay additional costs if you need extra treatment.

Coverage Eligibility

Anyone from any age group is eligible for a colon screening procedure. However, more attention is directed to people, both men and women of 50 years of age and above who are covered with Medicare Part B. Be sure to let your doctor know of any possible chronic conditions such as diabetes, allergies, heart conditions or pregnancy before proceeding with the screening.

Other Tests Covered Under Medicare

Medicare Part B qualifies to cover for various types of colorectal cancer screening tests and among them is the colonoscopy. Other cancer screening tests may be covered under this plan to detect growths early and start treatments right away.

  • Flexible sigmoidoscopy screening
  • Barium enema screening
  • Fecal occult blood testing
  • Multi-target stool DNA test

All these tests mentioned above have guidelines as to who meets the conditions to be covered by Medicare Part B and after how long one is passed to take another test to affirm a healthy colon state.

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