THE COLOGUARD® TEST: COST AND INSURANCE COVERAGE
Is the Cologuard test covered by insurance?
Medicare and most major insurers cover the Cologuard test. Let’s see if yours does.
Having trouble getting coverage? Just call our Customer Care Center at 1-844-870-8870. We’ll contact your insurance provider to see if we can help.
Most insured patients pay $01
Across the country, more than 96% of Cologuard patients have no out-of-pocket cost for screening.1
A number of national and regional insurers are already paying for colon cancer screening. Working with insurance companies is part of our commitment to expand coverage and access for patients ages 45 and above.
Colonoscopy coverage after a positive Cologuard test
Talking to your health care provider or a telehealth specialist will help you understand what a positive result means for you.
As of 2023, Medicare and most commercial plans cover a colonoscopy following a positive result using a Cologuard test. Exceptions for coverage may apply, so please confirm with your insurance.
If you receive a bill for a follow-up colonoscopy, please call our Customer Care Center 24/7 at 1-844-870-8870. You can also visit our appeals page to create a customized letter to send to your insurance.
What happened?
On January 10, 2022, the federal government issued new guidance related to coverage of preventive services under the Affordable Care Act.
What does this mean for patients?
- For plan or policy years beginning on or after May 31, 2022, health plans must cover, without cost sharing, a colonoscopy conducted after a positive stool-based test, including Cologuard.1
- Many health plans already waived the cost after a positive stool-based test. Several states also passed laws that require many plans in those states to cover colonoscopies after a positive stool-based test at no out-of-pocket cost to the patient.
- The federal update makes these protections even more available.
What happened?
The Centers for Medicare & Medicaid Services (CMS) finalized a new policy, effective January 1, 2023.
What does this mean for patients?
- The new policy removes Medicare cost-sharing requirements under Part B for colonoscopy after a patient has a positive stool-based test prior to the procedure.
- Some components of a colonoscopy (such as the removal of tissue) can result in the patient having coinsurance. This cost would apply regardless of whether the patient had a positive stool-based test.
- CMS lowered this cost sharing to 15%. CMS will gradually reduce this coinsurance until it’s completely removed by January 1, 2030.
Check your coverage
Medicare
The Cologuard test is covered by Medicare and Medicare Advantage with no co-pay or deductible for eligible patients ages 45-85.
Medicaid
Eligible patients who are actively enrolled in any State Medicaid program can request a Cologuard test. No payment will be expected from the patient unless the plan requires a co-pay.*
*The Cologuard test is a preventive service for NY Medicaid, and members have no financial responsibility.
Search insurance providers
Medicare and Medicare Advantage cover the Cologuard test with no co-pay or deductible for eligible patients ages 45-75. Type the name of your insurance into the search bar to see if your provider is in-network.
Provider Not Found
Don’t see your insurance provider?
If you don’t see your insurance provider, we’re here to help. Call our Customer Care Center at 1-844-870-8870 or send us a chat and we’ll happily check into things for you.
What does “In-network” mean?
“In-network” means that Exact Sciences Laboratories has contracted with the insurer to be part of their preferred lab network, and the insurer will cover the cost of the test if you meet certain clinical criteria.
Some insurers have coverage and network limitations and exclusions. We recommend that you call your insurer directly to confirm what they will pay, what they expect you will pay, and if any paperwork is required before you use the test.
Exact Sciences Laboratories does not verify insurance coverage or eligibility.
Even if your insurer is not in-network for the Cologuard test, it should be covered for eligible patients ages 45-75 with no co-pay or deductible, based on the Affordable Care Act.
*Please note that some insurers may be considered in-network with Exact Sciences Laboratories but do not allow the use of their company name or logo on our website. If you are unsure of your insurer’s status, please contact them directly for more information.
Our patient assistance program
We believe everyone should have access to the best health care options. Through our patient assistance program, we can help people who are facing challenges with insurance coverage so they can request a Cologuard test at no cost.
Is your household at or below 400 percent of the Federal Poverty Level (FPL)? If so, you might be able to receive Cologuard screening at no cost.2,3
If you apply to request a no-cost Cologuard test, you'll be asked to provide income documentation. If you qualify for other assistance programs, that may be enough to determine that you are eligible for our program.4
Those programs include, but are not limited to:
- Medicaid3
- Supplemental Nutrition Assistance Program (SNAP)
- Supplemental Security Income (SSI)
- Home Energy Assistance Program
Have questions about our assistance program or are interested in applying? Please call our Customer Care Center at 1-844-870-8870 and select “billing option.”