How Does Medicare Cover Colonoscopies?

Yes. Medicare Part B covers colonoscopies as a preventive screening benefit. For people at average risk, Medicare covers one colonoscopy every 10 years. For people at high risk — due to personal or family history of colorectal cancer or polyps — Medicare covers one colonoscopy every 24 months.

When a colonoscopy is performed purely as a preventive screening with no findings, Medicare covers 100% of the cost with no deductible and no coinsurance. You pay nothing.

This is where many beneficiaries are caught off guard. If your doctor finds and removes a polyp during what was scheduled as a preventive colonoscopy, the procedure may be reclassified from preventive to therapeutic — and your normal Part B cost-sharing (the 20% coinsurance) could apply.

The good news is that if you have a Medigap plan, that 20% is typically covered. Without supplemental coverage, however, you could face an unexpected bill after what you assumed was a fully covered screening.

Yes. Colonoscopies are typically performed in either a hospital outpatient department or an ambulatory surgery center (ASC). The cost-sharing and Medicare payment rates differ between these settings. ASCs generally result in lower overall costs, which matters if you have cost-sharing responsibilities.

Ask your doctor where the procedure will be performed and how it will be billed before your appointment.

If you have a Medicare Advantage plan, colonoscopies are still covered — but your cost-sharing will be governed by your plan's rules, not Original Medicare's. Some plans cover preventive colonoscopies at $0, while others may have copays or require that you use an in-network facility.

Always verify your plan's coverage details before scheduling. A quick call to your plan's customer service line or a conversation with your broker can save you from a surprise bill.