Insurance and Medicare
Several tests can be used to detect polyps or colorectal cancer. Each one can be used alone or in combination with each other. Most insurance plans and Medicare help pay for colorectal cancer screening for people who are aged 50 or older.
| Test | Private Insurance | Medicare |
|---|---|---|
| Fecal occult blood test (FOBT) | Many plans cover this test. | Covers once a year if you are 50 or older. You pay nothing for the test, but you generally have to pay 20% of the Medicare-approved amount for the doctor's visit. |
| Flexible sigmoidoscopy (flex sig) | Many plans cover this test every four to five years beginning at age 50. | Covers every four years if you are 50 or older. As of January 1, 2011, you pay nothing for this test if the doctor accepts assignment. If flexible sigmoidoscopy is done in an ambulatory surgical center or at a hospital outpatient department, you pay 25% of the Medicare-approved amount. |
| Colonoscopy | Coverage is variable when colonoscopy is used for screening. If it's needed for a follow-up test or diagnosing a problem, most plans cover it. Check with your insurance plan. | Covers every 10 years as a screening test if you are not at high risk for colorectal cancer, but not within four years of having a screening flexible sigmoidoscopy. Covers every two years if you are at high risk. There is no minimum age for colonoscopy. As of January 1, 2011, you pay nothing for this test if the doctor accepts assignment. Colonoscopy is generally recommended as a follow-up test if anything unusual is found during one of the other screening tests. Medicare covers follow-up colonoscopy. If colonoscopy is done in an ambulatory surgical center or at a hospital outpatient department, you pay 25% of the Medicare-approved amount. |
| Double-contrast barium enema | Many plans cover this test. Check with your insurance plan. | Your doctor may order this test as a substitute for flexible sigmoidoscopy or colonoscopy. It is covered every four years if you are not at high risk or every two years if you are at high risk for colorectal cancer. You pay 20% of the Medicare-approved amount for the doctor's services. In a hospital outpatient setting, you also pay the hospital a copayment. |
If a screening test results in a biopsy or removal of a lesion or growth, the procedure is considered diagnostic and the deductible is applied.
More Information
For more information about Medicare coverage, visit www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1 (877) 486-2048.
For more information about colorectal cancer and colorectal cancer screening, call CDC-INFO at 1-800-CDC-INFO (232-4636), TTY: 1 (888) 232-6348 or send e-mail to cdcinfo@cdc.gov.
The 25 states and four tribes in CDC's Colorectal Cancer Control Program (CRCCP) provide colorectal cancer screening services to low-income men and women aged 50–64 years who are underinsured or uninsured for screening, when no other insurance is available.
If you do not have insurance, visit Help for the Uninsured.
Contact Us:
- Centers for Disease Control and Prevention
Division of Cancer Prevention and Control
4770 Buford Hwy NE
MS K-64
Atlanta, GA 30341 - 800-CDC-INFO
(800-232-4636)
TTY: (888) 232-6348
8am–8pm ET
Monday–Friday
Closed on Holidays - cdcinfo@cdc.gov
