Dear Marci,
I’m going in for my first routine colonoscopy and want to know if I’ll have a copay at the doctor’s office. I was told colon cancer screenings were free through Medicare. Do you know if that’s right?
-Mateo (Santa Fe, NM)
Dear Mateo,
Medicare covers preventive screenings, including colonoscopies, in full. This means that you will have no cost-sharing as long as:
- The service is preventative, meaning you haven’t had any related symptoms that triggered the testing
- You see a participating provider for your colonoscopy if you have Original Medicare, or
- You see an in-network provider if you have a Medicare Advantage plan
If you meet the above requirements, you won’t have a copay for your colonoscopy. You should be aware, though, that if during your exam, the doctor determines that they need to perform more testing due to any findings or that they need to treat any findings, these additional services would be diagnostic and normal cost- sharing rules would apply. If the doctor removes any tissue or polyps during the screening colonoscopy, you will have a copay for that portion of the service, but the Part B deductible will not apply.
If you are at high risk for colorectal cancer, you will be eligible for another screening colonoscopy 24 months (2 years) after your first. If you are not at high risk, your next fully covered screening colonoscopy will be after 120 months (10 years).
To learn more about colon cancer screenings visit, Medicare Interactive.
-Marci
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