Medicare covers the costs of screening colonoscopies at specific time intervals based on a person’s risk for colorectal cancer. The test is usually free, but there is a coinsurance if they need a polyp removal.
A screening colonoscopy is a medical procedure in which a doctor uses a flexible, camera-equipped scope to examine the large intestines, primarily to screen for colorectal cancer and remove polyps.
Colonoscopies can be crucial, as colorectal cancer is the
Approximately
In this article, we explain how Medicare covers colonoscopy costs and what a person can expect to pay out of pocket for the procedure.
Glossary of Medicare terms
- Out-of-pocket cost: This is the amount a person must pay for care when Medicare does not pay the total amount or offer coverage. Costs can include deductibles, coinsurance, copayments, and premiums.
- Premium: This is the amount of money someone pays each month for Medicare coverage.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before Medicare starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, coinsurance is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Original Medicare (parts A and B) covers screening colonoscopy costs as long as the doctor who performs the test accepts assignment. Accepting assignment means that they agree to Medicare reimbursing them at a standard rate for screening colonoscopies.
Medicare will cover screening colonoscopies at the following intervals:
- Once every 24 months: This interval is for people who have a higher-than-average risk of colorectal cancer due to a family or personal history of the disease.
- Once every 48 months: Medicare will fund this after a person has had a flexible sigmoidoscopy. In this examination, the doctor inserts the colonoscope into the sigmoid colon but no deeper.
- Once every 120 months: People who are not at increased risk of colorectal cancer will get coverage for a test every 10 years.
If a doctor thinks that Medicare will not cover a person’s colonoscopy costs, they must provide the individual with an explanation called an Advance Beneficiary Notice of Noncoverage (ABN).
According to a 2019 study, the average clinical cost per person for a colonoscopy is about
Medicare Part A would cover a colonoscopy when a person is hospitalized, whereas Part B would cover it as an outpatient procedure. In addition, a Medicare Advantage (Part C) plan would provide equivalent coverage to Original Medicare (parts A and B).
Part A
Most people don’t pay a premium for Part A, but they must meet a $1,676 deductible. Once they do, Part A will fully cover their hospital stay and any procedures needed during that time for the first 60 days. Afterward, a person begins accruing a daily cost.
Does Medicare pay for colonoscopy anesthesia?
Although roughly 51% of all gastrointestinal procedures, including colonoscopies, involve anesthesia, the Centers for Medicare & Medicaid Services (CMS)
Part B
For most medical care, when it comes to Part B, after a person meets their deductible of $257, Part B will pay for 80% of any covered treatment or service. That said, colonoscopies do not count toward the Part B deductibles.
This means that if the person’s doctor accepts Medicare and the colonoscopy is straightforward, Part B will cover 100% of the cost. However, the person will still have to pay their monthly premium, which starts at $185, depending on the person’s income.
What is the loophole in a Medicare colonoscopy?
The Medicare colonoscopy loophole pertains to Medicare fully covering screening colonoscopies, but not including the removal of polyps in this coverage.
Polyps are growths in the lining of the rectum and colon. Although many polyps are not cancerous in the beginning, they
If a doctor finds polyps during a colonoscopy, the procedure becomes diagnostic rather than screening. In this case, a person will have to pay 15% of the Medicare-approved amount for the procedure.
In addition, the doctor may then also recommend another diagnostic colonoscopy
That said, although undergoing a diagnostic colonoscopy can have some financial impact, the cost of treating colorectal cancer is much higher than that of preventive screening.
Medicare Advantage
A person has the option of signing up for Medicare Advantage (Part C), which is an alternative to Original Medicare (parts A and B). These plans must provide the same coverage as Original Medicare.
However, Part C plans are managed by private insurers and have different premiums, deductibles, and coinsurance depending on a person’s plan.
According to the Centers for Medicaid & Medicare (CMS), the average monthly premium for Part C plans is around $17.00 in 2025.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
If a doctor accepts an assignment, Medicare covers the cost of standard screening colonoscopies.
If a doctor has to remove polyps from a person’s colon or rectum, the procedure becomes a diagnostic colonoscopy, and the individual will be responsible for additional costs.
A doctor is responsible for providing individuals with an explanation called an ABN if they have reason to think that Medicare will not cover colonoscopy costs.