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Colonoscopies: Know Your Insurance Coverage
3/24/2017 2:20:54 PM
When scheduling your colonoscopy, make sure your covered benefit is covered.

Colonoscopies: Know Your Insurance Coverage

Corewell Health

Colonoscopies: Know Your Insurance Coverage


Your doctor says those four words and you cringe just a little - “Let’s schedule your colonoscopy.” 

There are a lot of things you could worry about when it’s time for this colorectal cancer screening; the prep, the test itself. But what about the cost?

Under the Affordable Care Act, the health care reform law passed in 2010, most insurance plans must cover screening for colorectal cancer, including colonoscopy. Depending on your insurance plan, this could mean no out-of-pocket cost for you. 

That’s great news for most people with some sort of insurance coverage. However, there are still a few things to be aware of when scheduling your colonoscopy to make sure you are getting the best possible coverage.


Karen Stachura, director of the Beaumont Employee Health Plan, says even though the ACA requires health plans to cover preventative screenings like colonoscopies, the plan can decide which networks they will pay for the test.

“Often times, members of a specific insurance plan can’t just go to a provider in any network to get their screenings,” says Stachura. “It’s important to review your plan’s coverage information in regards to preventative screenings and which network within the plan is provide to members with no out-of-pocket costs.”


In general, Medicare Part B (Medical Insurance) covers a screening colonoscopy once every 24 months if you are at high risk for colorectal cancer, or once every 10 years if you are not high risk. 

To find out how much your specific test, item or service will cost with Medicare, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:

  • other insurance you may have
  • how much your doctor charges
  • whether your doctor accepts Medicare
  • the type of facility
  • the location where you get your test, item, or service


If you don’t have insurance, there are resources available to ensure you are getting important preventative screenings, like a colonoscopy.

The Health Resources and Services Administration provides information on local health centers that provide free or low cost screenings for the uninsured and underinsured population.

Stachura said the best way to make sure you understand your coverage and what cost might be associated with tests and screenings is to call your insurance provider before making your appointment.

“Each insurance provider is different so it’s important to know your coverage before having any medical care, including those you might assume are covered.”  

Don’t wait until it's too late. For a colonoscopy referral talk to your doctor or call 800-633-7377 today.

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