Medicare coverage of colorectal cancer screenings

With Medicare, you must be 50 or older to be eligible for coverage of most colon cancer screenings. The exception to this is a colonoscopy, for which there is no minimum age requirement.

Medicare covers the following screenings:

• Fecal occult blood test - once a year (every 12 months) for persons age 50 or older
• Flexible sigmoidoscopy - once every four years (48 months) for persons at high risk and less frequently for other persons
• Colonoscopy - once every two years (24 months) if you are at high risk for colorectal cancer (e.g. have a family history of the disease or have had colorectal polyps or colorectal cancer, or have had inflammatory bowel disease). If you are not at high-risk, Medicare covers colonoscopies every 10 years (but not within 48 months of a screening flexible sigmoidoscopy).
• Barium enema – once every two years for persons at high risk and once every four year for others (but not within 48 months of a screening flexible sigmoidoscopy).

Since 2011, if you have Original Medicare, no coinsurance or deductible applies to the fecal occult blood test, flexible sigmiodoscopy or colonoscopy if you see doctors who take assignment. Doctors and other health care providers who take assignment cannot charge you more than the Medicare approved amount. If you are in a Medicare Advantage plan, contact your plan to find out what rules and costs apply. Starting in 2012, Medicare Advantage (MA) plans will cover all preventive services the same as Original Medicare. This means MA plans will not be allowed to charge cost-sharing fees (coinsurances, copays or deductibles) for preventive services that Original Medicare does not charge for as long as you see in-network providers. If you see providers that are not in your plan’s network, charges will typically apply.

If you have a barium enema, you will pay 80 percent of the Medicare approved amount if your doctor takes assignment. The Part B deductible does not apply.

If you have a colonoscopy and your provider finds and removes a polyp, costs will apply. You would have to pay the coinsurance for your colonoscopy and the polyp removal because the screening became diagnostic. However, no deductible will apply.