Cologuard®
Insurance Coverage

Most insured patients pay $0*

Cologuard is covered by Medicare and most major insurers.

94%

Nationwide, more than 94% of Cologuard patients have no out-of-pocket cost for screening.*

  • Read more

    Many national and regional insurers have begun paying for colon cancer screening at 45. Exact Sciences continues to work with payers to expand coverage and access for patients 45-49.

93%

Currently, >93% of Cologuard patients 45-49 have had no out-of-pocket cost for screening.*

  • Read more

    Many national and regional insurers have begun paying for colon cancer screening at 45. Exact Sciences continues to work with payers to expand coverage and access for patients 45-49.

Special Topic: Coverage for Colonoscopy After a Positive Cologuard Result

A patient with a positive Cologuard result should receive a colonoscopy for the screening to be completed. This helps you understand what this positive result means for you. Discuss your options with your healthcare provider.

Millions of patients have access to colonoscopy after a positive Cologuard test with no out-of-pocket cost. The federal government created patient financial protections that expand the number of plans covering these colonoscopies without cost. Read below for info on commercial health plans, Medicare and Medicare Advantage, and how they may cover a colonoscopy after a positive Cologuard test. Read more

  • Read more
    Commercially insured patients:
    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.
     
    Medicare and Medicare Advantage:
    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.
     
    Your insurer is the best source of info on your plan.
     
    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.

Find a specific insurer

Expand each of the categories below to look for your specific insurance plan. This is not an exhaustive list as plans are being added regularly.

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  • Medicare & Medicare Advantage|See details
    Cologuard is covered by Medicare and Medicare Advantage with no co-pay or deductible for eligible patients ages 45-85.
    Payor
    State
    • Traditional Medicare
      National
    • Medicare Advantage
      National
  • Medicaid|See details
    Eligible patients who are actively enrolled in any State Medicaid program can access Cologuard. No payment will be expected from the patient unless the plan requires a co-pay.*
    *Cologuard is a preventive service for NY Medicaid and members have no financial responsibility.
  • Commercial Insurance: In-Network|Find your region

    Select your region on the map to see if your insurance plan has contracted with Exact Sciences Laboratories to be part of their preferred lab network.*

    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 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 Cologuard, it should be covered for eligible patients ages 50-75 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 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.

    Cologuard insurance map

    West

    In Network Plans - Private Insurers

    Midwest

    In Network Plans - Private Insurers

    South

    Mid-Atlantic

    Northeast

    Payor
    State
    • 1199SEIU
      NY
    • Aetna
      National
    • Agewell
      NY
    • Alliant Health Plans/Health One Alliance
      GA
    • AllWays Health Partners, Inc. (fka Neighborhood Health Plan)
      MA
    • Amerihealth New Jersey
      NJ
    • Anthem Blue Cross and Blue Shield in Colorado
      CO
    • Anthem Blue Cross and Blue Shield – Kentucky
      KY
    • Anthem Blue Cross and Blue Shield in Virginia (PPO only; HMO Healthkeepers/Healthkeepers Plus must obtain in-network exception)
      VA
    • Anthem Blue Cross and Blue Shield – Connecticut
      CT
    • Anthem Blue Cross and Blue Shield – Indiana
      IN
    • Anthem Blue Cross and Blue Shield – Maine
      ME
    • Anthem Blue Cross and Blue Shield – Missouri
      MO
    • Anthem Blue Cross and Blue Shield – New Hampshire
      NH
    • Anthem Blue Cross and Blue Shield – Ohio
      OH
    • Anthem Blue Cross and Blue Shield – Wisconsin
      WI
    • Anthem Blue Cross and Blue Shield in Nevada
      NV
    • Anthem Blue Cross of California
      CA
    • Arise Health Plan/WPS Health Insurance
      WI
    • Aultcare
      OH
    • Avera Health Plans, Inc.
      SD
    • Beacon Health
      ME
    • Blue Cross and Blue Shield of Illinois
      IL
    • Blue Cross and Blue Shield of Kansas
      KS
    • Blue Cross and Blue Shield of Kansas City
      KS, MO
    • BlueCross BlueShield of Michigan and Blue Care Network of Michigan (JVHL BCN Participating Provider)
      MI
    • BlueCross BlueShield of Nebraska
      NE
    • Blue Cross & Blue Shield of Minnesota
      MN
    • Blue Cross Blue Shield of North Dakota
      ND
    • Blue Cross Blue Shield of Texas
      TX
    • Blue Cross and Blue Shield of Montana
      MT
    • Blue Cross and Blue Shield of New Mexico
      NM
    • Blue Cross Blue Shield of Arizona
      AZ
    • Blue Cross Blue Shield of Wyoming
      WY
    • Blue Cross & Blue Shield of Florida
      FL
    • Blue Cross and Blue Shield of Georgia, Inc. (PPO only; HMO/Open Access POS must obtain in-network exception)
      GA
    • Blue Cross of Idaho
      ID
    • Blue Cross & Blue Shield of Louisiana
      LA
    • Blue Cross & Blue Shield of Massachusetts
      MA
    • BlueShield of Northeastern New York
      NY
    • BlueCross BlueShield of Western New York
      NY
    • Blue Cross & Blue Shield of Rhode Island
      RI
    • Blue Cross and Blue Shield of Vermont
      VT
    • Blue Shield of California
      CA
    • BlueCross BlueShield of Alabama
      AL
    • BlueCross BlueShield of North Carolina (Participates in the Avalon Healthcare Solution network of laboratories)
      NC
    • BlueCross BlueShield of South Carolina (Participates in the Avalon Healthcare Solution network of laboratories)
      SC
    • BlueCross BlueShield of Tennessee
      TN
    • Bright Health Plan
      IL, OH, OK, NE, TX
    • Bright Health Plan
      NY
    • Bright Health Plan
      AZ, CA, CO, UT
    • Bright Health Plan
      NC, TN, VA
    • Bright Health Plan
      AL, FL, GA, SC
    • Capital BlueCross (Participates in the Avalon Healthcare Solution network of laboratories)
      PA
    • Capital District Physicians’ Health Plan
      NY
    • Care N Care Health Plan
      TX
    • CareFirst BlueCross BlueShield
      DC, MD, VA
    • CareSource Indiana
      IN
    • Centene - Ambetter of Tennessee
      TN
    • Centene - Ambetter of North Carolina Inc.
      NC
    • Centene - Arizona Complete Health (Ambetter and Allwell)
      AZ
    • Centene - Health Net of CA (Commercial Exchange and Medicare Advantage)
      CA
    • Centene - IlliniCare (Ambetter and Allwell)
      IL
    • Centene - MHS (Ambetter and Allwell)
      IN
    • Centene - Sunflower Health Plan (Ambetter and Allwell)
      KS
    • Centene - Buckeye Health Plan (Ambetter and Allwell)
      OH
    • Centene - Superior Healthplan (Ambetter and Allwell)
      TX
    • Centene - MHS Health Wisconsin (Allwell)
      WI
    • Centene - Home State Health (Ambetter and Allwell)
      MO
    • Centene - Arkansas Health & Wellness (Ambetter and Allwell)
      AR
    • Centene - Coordinated Care (Ambetter and Allwell)
      WA
    • Centene - Trillium Community Health Plan (Med Adv)
      OR
    • Centene - Health Net Health Plan of Oregon (Med Adv)
      OR
    • Centene - SilverSummit Health Plan (Ambetter)
      NV
    • Centene - New Hampshire Health Families (Ambetter)
      NH
    • Centene - PA Health & Wellness (Ambetter and Allwell)
      PA
    • Centene - Sunshine Health (Ambetter and Allwell)
      FL
    • Centene - Peach State Health Plan (Ambetter and Allwell)
      GA
    • Centene - Louisiana Healthcare Connections (Allwell)
      LA
    • Centene - Magnolia Health (Ambetter and Allwell)
      MS
    • Centene - Absolute Total Care (Ambetter and Allwell)
      SC
    • Cigna
      National
    • Contra Costa Health Plan
      CA
    • Common Ground Healthcare Cooperative
      WI
    • ConnectiCare, Inc.
      MA, RI, NY, CT
    • Coquille Tribe
      OR
    • Culinary Health Fund
      NV
    • Dean Health Plan/Prevea360 Health Plan
      WI
    • EmblemHealth
      NY
    • Empire BlueCross BlueShield
      NY
    • Excellus BlueCross BlueShield
      NY
    • Fallon Community Health Plan
      MA
    • Fidelis Care
      NY
    • FirstCarolinaCare
      NC
    • Florida Health Care Plans, Inc.
      FL
    • Gateway Health Plan – HealthChoices (Med Adv)
      PA
    • Geisinger Health Plan
      PA
    • Global Health
      OK
    • Group Health Cooperative Eau Claire
      WI
    • Group Health Cooperative of South Central WI
      WI
    • Harvard Pilgrim Health Plan
      MA
    • Health Alliance Medical Plans, Inc.
      IL
    • Health Alliance Plan of Michigan
      MI
    • Health First Health Plan
      FL
    • Health Net Federal Services, LLC (TRICARE West Region)*
      AK, HI, WA, OR, CA, ID, NV, UT,CO, AZ, NM, MT, WY
    • Health Net Federal Services, LLC (TRICARE West Region)*
      TX, KS, MO, IA, NE, NM, ND, SD
    • Health New England
      CT, MA
    • Health Plan of Nevada
      NV
    • HealthChoice
      OK
    • Healthfirst
      NY
    • HealthPartners
      MN, IA, WI
    • Health Tradition Health Plan
      WI
    • Healthsmart World Trade Center Health Plan
      NY
    • Highmark Blue Cross and Blue Shield
      PA, WV, DE
    • HMSA
      HI
    • Hometown Health
      NV
    • Horizon Blue Cross Blue Shield of New Jersey
      NJ
    • Humana
      National
    • IdealCare by Sendero Health Plans
      TX
    • Independent Health Association
      NY
    • Indiana University Health Plans
      IN
    • Johns Hopkins Employer Health Programs
      MD
    • Johns Hopkins US Family Health Plan
      MD
    • Kaiser Foundation Health Plan of Washington
      ID, WA
    • Maine Community Health Options
      ME
    • McLaren
      MI
    • Medica Health Plans
      MN, IA, KS, NE, ND, SD, WI
    • Medical Associates Health Plan
      IA, IL, WI
    • Medical Mutual of Ohio
      OH
    • MedStar Family Choice
      MD
    • MercyCare Health Plan
      WI, IL
    • MHS Wisconsin
      WI
    • Moda Health
      OR
    • Molina Healthcare
      CA, NM, WA, UT, ID
    • Molina Healthcare
      NY
    • Molina Healthcare
      FL
    • Molina Healthcare
      MI, OH, TX, WI
    • Mountain Health CO-OP
      ID, MT
    • MS State and School Employees' Health Insurance Plan
      MS
    • Neighborhood Health Plan of Rhode Island
      RI
    • Network Health
      WI
    • New Mexico Health Connections
      NM
    • Ohio State University Health Plan
      OH
    • Optima Health
      VA
    • Oscar Health Insurance
      AZ, CA, CO
    • Oscar Health Insurance
      TN, VA, PA
    • Oscar Health Insurance
      KS, MO, MI, TX, OH
    • Oscar Health Insurance
      NY, NJ
    • Oscar Health Insurance
      FL, GA
    • PacificSource Health Plans
      OR, ID, MT
    • Partners Health Plan
      NY
    • Physicians Health Plan of Northern Indiana
      IN
    • Physicians Health Plan
      MI
    • Physicians Plus
      WI
    • Piedmont Community Health Plan
      VA
    • Preferred Health Choice
      IA, IL, WI
    • Preferred One
      MN
    • Priority Health
      MI
    • Prominence Health Plan
      NV
    • Prominence Health Plan
      TX
    • Providence Health Plan
      OR
    • Public Employees Health Plan (PEHP)
      UT
    • Quad City Community Healthcare
      IA
    • Regence BlueCross BlueShield of Oregon
      OR
    • Regence BlueCross BlueShield of Utah
      UT
    • Regence BlueShield of Idaho
      ID
    • Regence BlueShield of Washington
      WA
    • Rocky Mountain Health Plan
      CO
    • Sanford Health Plan
      SD
    • Scripps Health Plan Services
      CA
    • SelectHealth
      ID, NV, UT
    • Sentara Health Plan
      VA
    • Sierra Health and Life
      NV
    • Signature Care Network
      IN
    • SummaCare
      OH
    • Total Healthcare
      MI
    • Tufts Health Plan
      MA, RI, NH
    • United Healthcare
      National
    • United Medical Resources (UMR)
      National
    • University of Utah Health Plans
      UT, ID
    • Unity Health Plan
      WI
    • Univera Healthcare
      NY
    • UPMC
      PA
    • US Family Health Plan of New York
      NY
    • Virginia Premier
      VA
    • WEA Trust
      WI
    • Wellmark Blue Cross and Blue Shield of Iowa
      IA
    • Wellmark Blue Cross and Blue Shield of South Dakota
      SD

    In Network Plans - Medical Groups And IPAs

    Payor
    State
    • Access Medical Group (HMO)
      CA
    • Affinity Medical Group (CA)
      CA
    • Austin Regional Independent Associates (ARIA)
      TX
    • Axminster Medical Group
      CA
    • Brown and Toland Physicians (HMO)
      CA
    • California IPA
      CA
    • Central Valley Medical Providers (CA)
      CA
    • Choice Medical Group
      CA
    • Community Care IPA
      CA
    • Dignity Health Medical Foundation - Mercy Medical Group
      CA
    • Dignity Health Medical Foundation - Woodland Clinic
      CA
    • Dignity Health Medical Network – Central California
      CA
    • Dignity Health Medical Network - Inland Empire
      CA
    • Dignity Health Medical Network - Santa Cruz
      CA
    • Facey Medical Group (HMO)
      CA
    • Hospital Sisters Health System
      IL
    • Humboldt IPA
      CA
    • Illinois Physicians Alliance
      IL
    • John Muir Health Physician Network
      CA
    • Lakeside Medical Organization, a Medical Group, Inc.
      CA
    • Medi Choice IPA
      CA
    • Meritage Medical Network (HMO)
      CA
    • Methodist First Choice
      IL
    • Monarch Healthcare
      CA
    • NorthBay Healthcare
      CA
    • OSF Healthcare System
      IL
    • Palo Alto Medical Foundation
      CA
    • Physicians Association of Illinois
      IL
    • Physicians Care Network
      IL
    • Premier Care IPA
      CA
    • Progress Health
      IL
    • Regal Medical Group, Inc.
      CA
    • SanSum Clinic (HMO)
      CA
    • Santa Clara County IPA
      CA
    • Sante Medical Group (CA)
      CA
    • Scripps Coastal Medical Center (CA)
      CA
    • Scripps Coastal Medical Group (CA)
      CA
    • Scripps Physician Medical Group (CA)
      CA
    • Seoul Medical Group (HMO)
      CA
    • Sinai Medical Group
      IL
    • St. John's Health Center
      CA
    • Sutter East Bay Medical Foundation
      CA
    • Sutter Gould Medical Foundation
      CA
    • Sutter Independent Physicians
      CA
    • Sutter Medical Foundation
      CA
    • Sutter Pacific Medical Foundation
      CA
    • Swedish Covenant Physician Partners
      IL
    • Torrance Health IPA
      CA

    * TRICARE is a registered trademark of the Department of Defense, Defense Health Agency. All rights reserved

Last updated January 2023.

If you have any questions, Customer Care is available 24/7 at 1-844-870-8870

* Exact Sciences estimate based on historical patient billing. Rate of coverage varies by state and region. Exceptions for coverage may apply; only your patients' insurers can confirm how Cologuard would be covered.

  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. Accessed November 22, 2022.

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