Most insured
people pay $0*
Cologuard® is covered by Medicare and most major insurers
Nationwide, more than 94% of Cologuard patients have no out-of-pocket cost for screening.*
*Exact Sciences estimate based on historical patient billing from October 1, 2019 – January 31, 2020. Rate of coverage varies by state and region. Exceptions for coverage may apply; only your insurer can confirm how Cologuard would be covered for you.
Special Topic: Insurance for Colonoscopy After a Positive Cologuard Result
It is important that you fully complete your colon cancer screening. If you have a positive Cologuard test result, you should discuss it with your healthcare provider and have a colonoscopy to see what this positive result means for you.
Millions of patients have access to this colonoscopy with no out-of-pocket cost. Additionally, the federal government is adding new patient protections that will rapidly increase the number of plans covering these colonoscopies free of out-of-pocket costs. Still, the best way to understand what is covered by your plan is to call your insurer directly. Here is some additional information about commercial health plans, Medicare and Medicare Advantage and how they may cover a colonoscopy after a positive Cologuard test. Read more
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Commercially insured patients:
On January 10, 2022, the Department of Labor put out new guidance related to coverage of preventive services under the Affordable Care Act. For plan or policy years beginning on or after May 31, 2022, health plans are required to cover, without cost sharing, a colonoscopy conducted after a positive stool-based test, like Cologuard1. Many health plans already cover a colonoscopy after a positive stool-based test with no out-of-pocket cost to the patient. Several states have also passed state laws that require some plans in those states to cover colonoscopies after a positive stool-based test at no out-of-pocket cost to the patient.
Medicare and Medicare Advantage:
The Centers for Medicare & Medicaid Services (CMS) is in the process of updating its policy around colonoscopy after a positive stool-based screening test. Until CMS finalizes its new policy (expected January 2023), people with Medicare Part B may receive a bill for this type of colonoscopy that includes co-insurance (typically 20%) and the deductible. People with Medicare Advantage may receive a bill for a colonoscopy following a positive stool-based screening test that includes co-insurance (in varying amounts, depending on the plan) and a deductible2.
If you receive a bill for a colonoscopy, please call our Customer Care Center 24/7 at 1-844-870-8870 or visit our appeals page to create a customized letter to send to your insurance company.
References:
1. See FAQS ABOUT AFFORDABLE CARE ACT IMPLEMENTATION PART 51, FAMILIES FIRST CORONAVIRUS RESPONSE ACT AND CORONAVIRUS AID, RELIEF, AND ECONOMIC SECURITY ACT IMPLEMENTATION at https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs#Affordable_Care_Act. 2. See Medicare Claims Processing Manual, Chapter 18 - Preventive and Screening Services https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c18pdf.pdf