UPDATED: AUGUST 28, 2023 | 1 MIN READ
A colonoscopy is a preventative care screening test that helps detect colon cancer. Seeing the signs of cancer early enough makes preventing or treating cancer easier. Understanding your health insurance coverage lets you determine if you will be out of pocket for expenses.
What is a colonoscopy, and do you need one?
Men and women over 45 should be screened every ten years. But, if your family is at high risk of colon cancer, your doctor might recommend you get one sooner.
What’s a colonoscopy?
A colonoscopy examines your colon/large intestine using a thin tube and a camera called an endoscope. If the doctor sees a growth, he will take a sample for biopsy.
What happens during a colonoscopy?
You are given a sedative to relax. Then, the doctor looks at your colon with an endoscope. You are awake, but you aren’t aware of it. Afterward, you recover in a room while the doctor reviews your results. If a biopsy occurs, you get the results in a few days.
What’s the difference between a screening colonoscopy and a diagnostic one?
A colonoscopy is a preventative care service and an essential health benefit under the Affordable Care Act. People get preventive colonoscopies to check for polyps, which could be cancerous.
During a diagnostic colonoscopy, the doctor already knows there’s an issue. In this case, the doctor completes the colonoscopy to take a biopsy for a diagnosis.
Who needs to get a colonoscopy?
Any man or woman over 45 can get a colonoscopy and one continuing every ten years. You should consider getting one sooner if colon cancer runs in your family.
Does health insurance cover a colonoscopy?
The Affordable Care Act (ACA) requires insurance companies to cover certain preventative services such as colonoscopies. But, insurance companies have established strict guidelines for determining what a preventive service is. Those guidelines may exclude people with already symptoms or colon cancer in their family history.
Does private health insurance cover colonoscopies?
Coverage for diagnostic colonoscopies varies. Ask your insurer about co-pays, deductibles, limits, exclusions, or other out-of-pocket expenses.
Does marketplace health insurance cover a colonoscopy?
Yes, the types of insurance plans from the Marketplace cover the costs of a colonoscopy. However, you might incur out-of-pocket expenses, such as a bowel prep kit, anesthesia, pathology, and a facility fee.
Does Medicare cover a colonoscopy?
Medicare pays the total cost of a preventive colonoscopy as long as a medical provider who accepts Medicare does the procedure. If they find a polyp and perform a biopsy, it’s considered diagnostic rather than preventive, and you could need to pay 20 percent.
Does Medicaid cover a colonoscopy?
States have mandated colonoscopy screening under Medicaid. However, Medicaid might not cover a colorectal cancer screening before age 45 if you don’t have symptoms.
What to do if your insurance won’t cover your colonoscopy
If your insurance doesn’t cover a colonoscopy, a few options exist.
Can your health insurance cover a colonoscopy if you’re under 45?
Getting a colonoscopy before the age of 45 depends on your medical history. If you are at high risk of colon cancer due to family history or are exhibiting signs of colon cancer, you are eligible for coverage for the procedure.
Advocating for your health is essential to getting your healthcare needs met. If you need a colonoscopy, ask your doctor about it during your annual physical exam.
Alternatives to a colonoscopy
A colonoscopy is the best way to determine if you have colon cancer. There are other tests, but they are not as accurate:
- Stool test: looks only at stool
- Fecal DNA: looks at cancer cells inside fecal mater
- Flexible sigmoidoscopy: looks at the lower colon
- CT Colonography: low-dose radiation to view a picture of the colon
Is anesthesia covered by insurance for colonoscopy?
Anesthesia is covered fully if your doctor determines that anesthesia is medically necessary.
Is a colonoscopy considered surgery for insurance purposes?
Colonoscopy can be a preventive service. However, if the healthcare provider finds any problems, It can become outpatient surgery. The procedure takes place in a hospital and enables a surgeon to examine the lining of the colon and rectum.
Is a colonoscopy considered preventative?
Yes, your doctors can treat colon cancer. The earlier the cancer detection, the better the chance of a successful treatment.
Are colonoscopies free under the Affordable Care Act?
The Affordable Care Act deemed colonoscopies essential health care at no cost to the patient.
Can you be awake during a colonoscopy?
Yes, but you’re not aware of the procedure.
Finding Insurance That Covers Colonoscopies
Health insurance covers all your needs, including preventive services such as colonoscopies. Get a health insurance quote to determine available coverages and the costs involved.