Is There An Alternative To Having A Colonoscopy
Yes. For individuals who wish to avoid having a colonoscopy, there are actually several alternatives available:
- Flexible sigmoidoscopy: Although this procedure still involves the insertion of a tube into the rectum, it only looks at the rectum and lower colon and doesnt require sedation. However, it still requires a traditional preparation prior to the procedure.
- Virtual colonoscopy: Using a quick CT scan to provide a view of the inside of the colon, a virtual colonoscopy is a less-invasive alternative to a traditional colonoscopy. It still requires traditional prepping beforehand to empty the colon.
- Stool testing: For stool testing, you must obtain a small stool sample, which is sent to a lab for fecal immunochemical testing and/or DNA analysis. Cologuard is a simple at-home stool-collection kit thats designed to be used every three years. However, it isnt recommended for individuals with an increased risk of colorectal cancer or those who are exhibiting symptoms such as bleeding or undiagnosed abdominal pain.
- Colon capsule testing: This up-and-coming diagnostic exam involves swallowing a pill-sized camera that takes photographs of the digestive tract. Unfortunately, it isnt currently sensitive enough to be reliable as a primary screening option, especially for individuals who have a higher-than-average risk of colon cancer.
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Colonoscopies and other colorectal screenings can be helpful in detecting precancerous polyps or colorectal cancer at an early stage. These fall under Medicares definition of preventive and screening services.
If you dont have a high risk for colorectal cancer, Medicare Part B will cover a colonoscopy once every ten years, or 48 months following a flexible sigmoidoscopy. Medicare Part B may also help cover other types of colorectal cancer screenings.
Take Care Of Your Health
Unlike many cancers, colon cancer is preventable.11 Regular colonoscopy screenings may help detect polyps or other growths that could be a concern and alert your doctor to remove them.
And rememberyour colonoscopy screenings can be covered under your Medicare Part B coverage. If youre unsure whether youre due for a colonoscopy, reach out to your healthcare provider today.
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How Do Medigap Plans Cover Colonoscopies
Your Medigap plan pays for colonoscopy costs left over after Medicare pays.
Medicare pays only 80% of the cost for a diagnostic colonoscopy, meaning you pay the remaining 20%. You would submit those charges to your Medigap plan, which would pay all or part of the cost, depending on your policy.
Medicare provides a free screening colonoscopy every 24 months for high-risk patients and every 10 years for people at low risk for colorectal cancer. Since the procedure is covered in full, you have no out-of-pocket costs to file with your Medigap plan.
If It Is A Diagnostic Screening
If your doctor finds and removes a polyp or other tissue during your colonoscopy, Medicare considers it diagnostic,12 even if you went in for a preventive screening. For diagnostic colonoscopies, you may pay coinsurance 20% of the bill plus a copayment if you get your colonoscopy in a hospital. Your Part B deductible does not apply.
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What Do I Need To Bring With Me For My Procedure
Please bring a list of your current medications including over-the-counter medicines, as well as a current copy of your insurance card. It is advisable for you to bring the phone number of the person who will be picking you up after the procedure . Dress in comfortable clothing. Do not wear jewelry or finger nail polish.
How Much Does A Colonoscopy Cost Out Of Pocket
Typically, a colonoscopy costs between $800 and $1,600 out of pocket, and costs may vary by location, physician and the duration of the procedure. For individuals who are completely uninsured, the procedure may cost upwards of $5,000 when factoring in anesthesia, follow-up visits and facility fees.
The Patient Prevention and Affordable Care Act requires all insurers to cover preventative screening exams, such as colonoscopies. However, if you have private insurance, you may be required to pay a copay, coinsurance or a deductible.
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Who Qualifies For Medicare
People aged 65 and older, disabled individuals, and people with end-stage renal disease or amyotrophic lateral sclerosis can qualify for Medicare. Medicare Part A pays hospital costs and Medicare Part B covers medical costs such as doctor visits and outpatient treatments and procedures like colonoscopies.
Does Medicare Advantage Cover Colonoscopies
Medicare Advantage plans cover at least the same colonoscopy services as Original Medicare. But along with regular screenings, Medicare Advantage policies provide added coverage for diagnostic colonoscopies, making Medicare Advantage the cheaper option for those services. The added benefits are similar across all plans we reviewed, with one exception.
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Colonoscopy And Polypectomy Costs
In some cases, your doctor will find a polyp when doing your colonoscopy. Removing a polyp can be done at the same time as your colonoscopy. In most cases, it will not take long or be invasive.
Polypectomies can come with an additional cost. If you undergo polypectomy, you will pay 20% of the Medicare-approved amount.
Does Medicare Cover Colonoscopies In 2022
Medicare Colonoscopy CoverageCost with MedicareOther Colon ScreeningsFinal ThoughtsFAQsIts Time for Medicare Annual Enrollment: Are You Ready?
If youre deemed a high risk for colorectal cancer, then Medicare will cover the full cost of colonoscopy screenings once every two years. For patients who arent at high risk, Medicare will still cover screenings every 10 years.
In this article, Ill review Medicares coverage for colonoscopies and whether other types of colon cancer screenings are included.
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Can A Screening Colonoscopy Become A Diagnostic Procedure
Yes. You may go in for a screening colonoscopy and end up needing a diagnostic colonoscopy. If your doctor finds and removes a polyp or other tissue during a screening, your colonoscopy is then considered diagnostic rather than preventive. In that case, you’ll be charged 20% of the cost of your doctors services.
When And What Can I Eat After My Procedure
You can eat as soon as you leave the procedure facility. It is recommended that your first meal consist of relatively âlightâ food such as chicken soup, a turkey sandwich, or eggs & toast. Since you will have received sedation and your stomach will be empty, eating anything too rich or heavy might give you an upset stomach. You may resume your normal diet after the initial meal following your procedure.
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If It Is A Preventive Screening
If you get your preventive colonoscopy from a healthcare provider who participates with Medicare and has agreed to accept assignment for Medicare-covered services, youll pay no copayment or deductible.11 Accepting assignment means that the provider agrees or is required by law to accept Medicare-approved amounts as payment in full. Most doctors who accept Medicare accept these payment terms, but its a good idea to confirm before you get services.
Colonoscopy Under Medicare Costs
Medicare has several parts that provide different types of medical services. This section explains how each component covers colonoscopy.
Medicare Part A
The A section of Medicare covers hospital-related expenses. If you need hospital inpatient care, Medicare Part A covers these costs.
At some point, you may need a colonoscopy in the hospital. Imagine you have a GI bleed. Medicare Part A covers these services, and Medicare Part B covers your doctors services. However, Medicare may require a copay or deductible for inpatient services. This is a single payment for 60 days in the hospital.
Medicare Part B
Part B covers medical and preventive care and includes outpatient care, such as a colonoscopy. Medicare Part B has a monthly fee and a yearly deductible. The deductible is variable but will be $198 in 2020.
In contrast, Medicare will cover colonoscopies regardless of whether they are used for screening or diagnostic purposes.
Medicare Part C
Medicare Advantage combines Parts A and B and prescription drug coverage. The Affordable Care Act requires Medicare Advantage plans to cover colonoscopies.
When choosing a Medicare Advantage plan, the most important consideration is whether the doctor and anesthesia providers are in-network with your Medicare Part C.
Medicares Part D
Prescription drug coverage is a supplement to the other parts of Medicare. Medicare Part D plans cover prescriptions for bowel preparation to help clear the colon before a colonoscopy.
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What Does Medicare Consider High Risk For Colonoscopy
Medicare covers colonoscopy screenings the most frequently for any high-risk patient.
The Centers for Medicare and Medicaid Services identifies you as high-risk if you meet one or more of the following:
- Having an immediate family member who has or had colorectal cancer or polyps. Direct family such as a child, sibling, or parent.
- Have a family history of colorectal cancer a family history of familial adenomatous polyps or having Lynch syndrome.
Does Medicare Pay For Colonoscopy Procedures
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Medicare coverage can be difficult to understand if youre new to the program. However, weve made it our mission to help seniors around the U.S. come to grips with everything to do with Medicare.
Colonoscopies are one of the best ways to ensure early diagnosis of colon or colorectal cancer and getting them regularly after the age of 45 is a must.
If youre wondering if Medicare covers a colonoscopy, then read our guide to understand what they pay for, what they dont, and when you can get Medicare to cover a colonoscopy.
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Single Course Of Treatment
A referral covers a single course of treatment for the referred condition. A single course of treatment is an initial attendance at the specialist or consultant physician. It includes subsequent attendances for the continuing management until the patient is referred back to the referring practitioner.
A new referral doesnt always mean a new course of treatment.
If a referral is for continuing management of a condition, the specialist or consultant physician must bill subsequent attendance items. However, you can bill an initial attendance item if it meets all the following:
- the referring practitioner decides the patients condition needs to be reviewed
- the patient is seen by the specialist or consultant physician after the expiry of the last referral
- the patient was last seen by the specialist or consultant physician more than 9 months earlier.
If the patient has a new or unrelated condition, the specialist can start a new course of treatment if there is a new referral in place.
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How Does Medicare Cover Diagnostic Colonoscopies Differently Than Preventative
Diagnostic colonoscopies are covered under Medicare Part B. Benefit recipients are subject to the Part B deductible, and generally, 20% after the deductible is met.
Keep in mind that health care providers cover differently depending on where the person has the procedure done and whether its inpatient or outpatient.
Enrolling in a Medigap plan ensures some or all of the associated costs may be paid. The copay varies depending on which plan letter the patient is enrolled in.
In most Medicare Advantage plans, there is a fixed copay. The copay may vary depending on where the procedure occurs.
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Does Medicare Cover These Screenings
Medicare covers several colorectal cancer screenings,20 though different rules and costs may apply.21
FOBT and FIT tests are covered every 12 months for enrollees 50 or older with a referral from your doctor or other qualified healthcare provider. If the doctor conducting the test accepts assignment or Medicare-approved payment you pay nothing.
At-home, multi-target stool DNA tests are covered once every three years if youre between age 50 and 85,22 at average risk, and showing no symptoms. If youre eligible, you pay nothing for the test if its performed by a provider who accepts Medicare assignment.
Flexible sigmoidoscopies are covered once every 48 months for most people aged 50 and older, or 120 months after a previous screening colonoscopy.23 If your doctor accepts assignment, you pay nothing. If this screening turns into a biopsy or removal of tissue, the procedure converts to a diagnostic test and your copayment or coinsurance will apply. However, the Part B deductible does not.
Double-contrast barium enemas are covered through Medicare Part B for enrollees age 50 and older once every 48 months in place of colonoscopy or flexible sigmoidoscopy, or once every 24 months for people who are considered high risk.24
You pay coinsurance 20% of the Medicare-approved amount for the doctors services, plus a copayment if the test is conducted in a hospital. As with other colorectal screening methods, the Part B deductible does not apply.
Which Parts Of Medicare Cover Colonoscopies
Different parts of Medicare may or may not cover your colonoscopy. Each part provides different kinds of coverage for different medical services.
Colonoscopy Coverage by Medicare Part
- Medicare Part A
- Covers a colonoscopy if you need one while you are hospitalized . You may have to pay a copayment or deductible.
- Medicare Part B
- Medicare Part B covers the costs of outpatient colorectal cancer screening colonoscopies. Part B pays the full cost whether or not youve met your deductible for the year. You will have to pay 20 percent of costs for removal of polyps or other tissue.
- Medicare Part C
- Federal law requires Medicare Advantage plans to cover screening colonoscopies. You need to make sure your doctor and anesthesiologist are in your plans network to avoid out-of-pocket costs.
- Medicare Part D
- Medicare Part D prescription drug plans may cover prescriptions for bowel preparation prior to a colonoscopy. Check with your Part D plan to determine what is or is not covered.
- Medigap
- Medicare supplemental insurance plans may help with out-of-pocket expenses if your doctor removes polyps or other tissue during a colonoscopy. Check with your Medigap plan to determine what it covers.
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Medicare Coverage For Preventative Colonoscopy Screenings
Medicare Part B covers preventative services, including colonoscopy screenings, at no charge. As mentioned above, the procedure will be considered diagnostic if a polyp is found. If the procedure is preventative, then there will be no cost.
If you have a Medicare Advantage plan, it is still covered as preventative and should be a $0 copay.
Since its secondary to Medicare, there is no cost of preventative screening in a Medicare Supplement.
Frequency Of Colonoscopy Screening
How often Medicare pays for screening depends on your risk. For people considered high risk, a screening colonoscopy can be performed every 24 months. To be clear, this is not based on the calendar year but on actual months. If your last colonoscopy was 23 months ago, Medicare will not cover it as a free screening test.
Medicare defines high risk as having one of the following conditions:
- A family history of hereditary nonpolyposis colorectal cancer
For people at low or average risk, screening is only covered every 120 months, or 48 months if their last colon cancer screening was by flexible sigmoidoscopy.
This does not mean Medicare wonât cover the test more frequently. If there is a medical reason for a colonoscopy, it may well be covered. You will be expected to pay the Part B coinsurance after paying down your annual deductible.
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What Are The Benefits Of Direct Access Colonoscopy
Direct Access Colonoscopy offers many benefits to patients and physicians.
First, it empowers patients to take charge of this preventive health screening and schedule it on their own time.
It saves you time because you dont need to make an appointment with your GI doctor in the office, said Dr. Swaroop. This type of colonoscopy saves you money, too, as you avoid paying a co-pay and other related expenses.
Direct Access Colonoscopies also enable doctors to perform endoscopic procedures in a timely and efficient manner while maintaining the highest quality standards.
When Should I Start To Get Screened
Colorectal cancer is the second most common cause of cancer death in the United States when men and women are combined, so its important to get screened regularly.2
The American Cancer Society recommends people at average risk for colorectal cancer begin screening at age 45. People at higher risk may need to start screening before age 45.3
For reference, the ACS states people at higher risk are those with:4
- A strong family history of colorectal cancer or certain types of polyps
- A personal history of colorectal cancer or certain types of polyps
- A personal history of inflammatory bowel disease
- A family history of a hereditary syndrome such as familial adenomatous polyposis or Lynch syndrome
- A history of radiation to the abdomen or pelvis to treat a prior cancer
Note: If you think or know youre at higher risk for colorectal cancer, talk to your healthcare provider about your best screening option and schedule.
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How Does Medicare Cover A Colonoscopy
Colonoscopy can be covered as either preventative or diagnostic, and a preventive colonoscopy will have no charge. The price of a diagnostic colonoscopy will vary depending on where the person has the procedure completed.
Difference Between Preventative and Diagnostic Colonoscopy
A preventative colonoscopy is a procedure to inspect and verify if polyps are present. If no polyps are found, it stays as preventative. However, if polyps are found, the colonoscopy will automatically become diagnostic, and the doctor will remove the polyps.
