Does Medicare Cover Colonoscopies?

Colorectal cancer is the third most common cancer in the United States. Colonoscopies help find and remove precancerous polyps. This can lower your risk of colorectal cancer.

As you get older, your risk goes up. Regular screening is an important part of staying healthy. If you are due for a colonoscopy, it’s important to understand what Medicare covers and what you may pay.

Colonoscopy Cost with Original Medicare

Medicare covers screening colonoscopies at no cost to you when the test is used for preventive care.

• If you are at high risk, Medicare covers a screening colonoscopy once every 24 months
• If you are not at high risk, it is covered once every 10 years, or 4 years after a flexible sigmoidoscopy

You pay $0 copay, $0 coinsurance, and no deductible for a screening colonoscopy.

If a polyp is found and removed during a screening colonoscopy, the test is treated as diagnostic. In this case:

• You generally pay 15% coinsurance if a screening colonoscopy leads to polyp removal
• Medicare Part B deductible does not apply

Where you get care can also affect your costs. Procedures performed in an ambulatory surgery center (ASC) often cost less than hospital outpatient settings.

The KelseyCare Advantage Difference

KelseyCare Advantage covers colonoscopies just like Original Medicare, but with added financial protection.

With Original Medicare:

• You typically pay 20% coinsurance for most other outpatient services
• There is no yearly limit on what you spend

With KelseyCare Advantage:

• Many services have set copays
• All plans include a yearly out-of-pocket maximum

This means there is a limit on what you pay each year. Once you reach that limit, your plan pays 100% of covered costs.

For example, instead of paying a percentage of the cost, you may have a set copay that could be as low as $200 for a colonoscopy with polyp removal at a Kelsey-Seybold Ambulatory Surgery Center, depending on your plan.

Kelsey-Seybold Ambulatory Surgery Centers

As a KelseyCare Advantage member, you have access to Kelsey-Seybold’s accredited Ambulatory Surgery Centers across the Greater Houston area.

These centers are designed to make your care more convenient and coordinated. Your primary care doctor, specialists, and care team work together and share your health information, helping create a smoother experience from start to finish.

Get the Colonoscopy Coverage You Need

Medicare covers colonoscopies, but your costs and experience can vary based on your plan and where you receive care. KelseyCare Advantage combines coverage with coordinated care to help make the process easier and more affordable. If you have questions about your options, our licensed local agents are here to help. Call 713-442-5646 (TTY: 711).