Does Insurance Cover a Colonoscopy?

Your health insurance will typically cover a colonoscopy in full, provided it’s a screening and you meet certain eligibility requirements. While diagnostic colonoscopies may also be covered, you will likely encounter out-of-pocket costs in the form of deductibles and copayments.

Keep reading to learn more about colonoscopies, including when health insurance covers them, potential procedure costs and how to access this crucial health screening without insurance.

On This Page

• 

  What Is a Colonoscopy?

• 

  Is Your Colonoscopy Covered by Insurance?

• 

  Are There Potential Follow-up Costs After a Colonoscopy?

• 

  How Much Does a Colonoscopy Cost Out of Pocket?

• 

  Are There Resources Available for Colonoscopy Patients Without Insurance?

• 

  FAQs

What Is a Colonoscopy?

A colonoscopy is an invasive procedure designed to observe your large intestine, often to check for potential colorectal cancer. A large, flexible, tube-like camera is inserted into the rectum and maneuvered to give physicians a visual of potentially cancerous polyps or tumors, inflammation, ulcers and more. Your colonoscopy may be performed in a physician’s office, hospital or ambulatory surgery center.^[1]

You can typically go home and may be able to resume normal activities the same day as your colonoscopy.^[2]

Colonoscopies are typically performed once every 10 years from ages 45 to 85 for people who aren’t considered high risk. However, high-risk individuals may need to get a colorectal cancer screening as often as once a year, potentially beginning before they turn 45.^[3] You may qualify as high risk if you have a family history of colorectal cancer, have type 2 diabetes, are overweight or obese or have previously had polyps or cancer removed.^[4]

A colonoscopy can also remove portions of the colon or polyps for microscopic review to check for potential cancer cells as part of a biopsy. Colonoscopies are vital in fighting colorectal cancer, as early detection can help prevent further long-term complications or death.

Is Your Colonoscopy Covered by Insurance?

Under the Affordable Care Act (ACA), private insurance companies and Medicare must cover the costs of a colonoscopy to screen for colorectal cancer with no out-of-pocket costs, such as copayments or deductibles.^[5] Screenings are typically performed on patients at average risk of developing this cancer and are considered preventive.

However, if a colonoscopy is considered diagnostic rather than preventive, it may incur out-of-pocket costs. Diagnostic procedures are not required to be covered in full by the ACA, but they are typically performed only after abnormal results from a prior test.^[5] Below, we’ll cover a few different types of health insurance and how they cover colonoscopies.

Private Insurance

Most health insurance companies typically will cover colonoscopy screenings, provided you’re at average risk and over the age of 45. However, you’ll likely need to cover deductibles and copayments if the procedure is diagnostic, and you may want to review your coverage with your insurance provider in advance to better anticipate your costs. There may also be additional costs if the physician is located outside of your insurer’s network.^[5]

Medicare

Medicare fully covers colonoscopy screenings every 10 years for patients at average risk, every two years for those at high risk and every four years for those who have had a flexible sigmoidoscopy, another type of gastrointestinal procedure. If you experience a positive result on a noninvasive stool-based screening, then a follow-up colonoscopy is considered a screening test as well.^[5]

There is technically no minimum age requirement for colonoscopies under Medicare, though most Medicare members are at least 65 years old.^[5][6]

If the procedure removes a polyp or other cancerous tissue during your colonoscopy, you will need to pay 15% of the Medicare-approved amount for the physician’s services out of pocket. Procedures done in an outpatient hospital or ambulatory surgical center will also require a 15% coinsurance payment. However, the deductible for Medicare Part B won’t apply.^[7]

Medicaid

While Medicaid programs are authorized to cover colonoscopy screenings, there are no federal requirements mandating that they do so, meaning coverage can vary from state to state. For example, Medicaid programs in some states may cover a colonoscopy screening only if the patient’s physician determines it’s medically necessary. Coverage may also vary depending on the managed care plan a person is enrolled in within a state.^[5]

Are There Potential Follow-up Costs After a Colonoscopy?

Depending on the results of your colonoscopy, you can often expect additional follow-up costs. After a colonoscopy, any tissue samples removed must be sent to a laboratory for analysis, which can add extra costs. Likewise, if these samples indicate signs of cancer, you may need additional and more elaborate procedures, each with its own fee.

If polyps were discovered and removed during your colonoscopy, you may be more likely to develop more polyps in the future, so your doctor may prescribe medications to lower your risk. These medications may be expensive and might not be covered by your insurance, so check beforehand. Generic versions of certain drugs may be available and can be up to 85% cheaper than their name-brand counterparts.^[8]

How Much Does a Colonoscopy Cost Out of Pocket?

Colonoscopies can be pricey, costing $2,750 on average without health insurance. However, costs can vary substantially depending on factors such as the city and state where you have the procedure. For example, the average cost of a colonoscopy in Atlanta ranges from $925 to $3,000, while in Los Angeles it ranges from $1,400 to $4,600.^[9]

Additionally, the type of facility you go to for your colonoscopy can affect costs. For example, the average cost of a colonoscopy in an inpatient facility is $4,350, while the same procedure costs $2,550 in an outpatient facility.^[9]

Can I Find Out the Cost of a Colonoscopy in Advance?

If you don’t have insurance or are otherwise planning on paying for a colonoscopy out of pocket, you can request a good-faith estimate from your physician before the procedure is performed. If your total bill after the procedure is at least $400 more than the estimate, you may be able to dispute the charge.^[10]

Meanwhile, if you’re planning on having your health insurance cover the costs of your colonoscopy, you may need to get prior authorization from your insurance company. If your insurer determines that the procedure is diagnostic in nature, it should be able to let you know how much you’ll need to cover out of pocket.

Are There Resources Available for Colonoscopy Patients Without Insurance?

If you don’t have enough insurance coverage or lack insurance entirely, you may qualify for free or low-cost colonoscopies. Resources offered by organizations like the Colorectal Cancer Alliance can help you find free screenings and financial assistance, and your state Department of Health may also offer free colonoscopy screenings. Additionally, some local hospitals, cancer centers and clinics may offer free cancer screenings.^[1]