People With Medicare
Colon (colorectal) Cancer Screening
What it is:
Cancer of the colon or rectum is called colorectal cancer.
Tests that look for blood in the stool or that look inside the colon or rectum can find these cancers. Medicare covers four different kinds of tests that can screen for colorectal cancer: Fecal Occult Blood Test, Flexible Sigmoidoscopy, Colonoscopy, and Barium Enema.
Why screening is important:
This cancer is more common in people over 50, and the risk increases with age. In the United States, it is the fourth most common cancer in men and women.
These tests help find growths in the colon (pre-cancerous polyps) so your doctor can remove them before they turn into cancer. Treatment works best when colorectal cancer is found early.
Who is covered:
People age 50 or older are covered for this screening.
How often is it covered:
How often your colorectal cancer screening is covered depends on the type of test being used and whether you are considered to be at higher risk of developing this type of cancer.
- Fecal Occult Blood Tests are covered once every 12 months.
- Flexible Sigmoidoscopy is covered once every 48 months if you are at high risk. If at low risk, it is covered once every 10 years but not within 10 years of a colonoscopy.
- Colonoscopy is covered once every 2 years if you are at high risk. If you are at low risk, it is covered once every 10 years but not within 4 years of a Flexible Sigmoidoscopy.
- Barium Enema is covered once every 2 years regardless of age if you are at high risk and when used instead of a Colonoscopy or Flexible Sigmoidoscopy. It is covered once every 4 years if you are at low risk and age 50 and older.
Ask your doctor how to get this screening.
What you pay:
What you pay depends on the type of test being done:
- You pay nothing for the fecal occult blood test, the flexible sigmoidoscopy, or the colonoscopy if you have Original Medicare and you see a doctor who "accepts assignment." Doctors who accept assignment agree to accept the amount that Medicare will pay for a visit or service (called the Medicare-approved amount) as payment in full.
- For the barium enema, you pay 20% of the Medicare-approved cost for the service. (There is no Part B deductible for the barium enema.) There is no cost for the barium enema if the the screening is done in a Critical Access Hospital.
If you are in a Medicare Advantage plan, the plan cannot charge you for the fecal occult blood test, the flexible sigmoidoscopy or the colonoscopy as long as you see an "in-network" provider, meaning a doctor who has an agreement to treat people who belong to the plan. If you use a provider outside your plan's network, it may cost you money. As for the barium enema, costs may apply. See your plan for specific cost amounts.
Note: You may have to pay for some costs in either Original Medicare or in a Medicare Advantage plan if your doctor does other tests or procedures during this visit that are not included as part of the service such as removing a polyp. Talk with your doctor.
Learn more about Colorectal Cancer Screening on Medicare.gov.
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