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 this test once a year. You pay nothing. |
| Flexible sigmoidoscopy (flex sig) | Many plans cover this test every four to five years beginning at age 50. | Covers this test every four years. You pay 20% of the Medicare-approved amount after the yearly Part B deductible.* |
| Combination FOBT and flex sig | Many plans cover this test every four to five years beginning at age 50. | Covers this test every four years. You pay 20% of the Medicare-approved amount after the yearly Part B deductible.* |
| 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 this test every 10 years if you are not at high risk for colorectal cancer, but not within four years of having flexible sigmoidoscopy. Covers this test every two years if you are at high risk. There is no minimum age for colonoscopy. You pay 20% of the Medicare-approved amount after the yearly Part B deductible.* Colonoscopy also 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. |
| 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 after the yearly Part B deductible. |
*If flexible sigmoidoscopy or colonoscopy is done in an ambulatory surgical center or at a hospital outpatient department, you pay 25% of the Medicare-approved amount.
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 CDCINFO at 1-800-CDC-INFO (232-4636), TTY: 1 (888) 232-6348 or send e-mail to cdcinfo@cdc.gov.
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
24 Hours/Every Day - cdcinfo@cdc.gov
