Cologuard®
Insurance Coverage
Most insured patients pay $0*
Cologuard is covered by Medicare and most major insurers.
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
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Read moreCommercially 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 detailsCologuard is covered by Medicare and Medicare Advantage with no co-pay or deductible for eligible patients ages 45-85.PayorState
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Traditional MedicareNational
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Medicare AdvantageNational
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Medicaid|See detailsEligible 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.
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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.
West
In Network Plans - Private Insurers
Midwest
In Network Plans - Private Insurers
South
Mid-Atlantic
Northeast
PayorState-
1199SEIUNY
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AetnaNational
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AgewellNY
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Alliant Health Plans/Health One AllianceGA
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AllWays Health Partners, Inc. (fka Neighborhood Health Plan)MA
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Amerihealth New JerseyNJ
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Anthem Blue Cross and Blue Shield in ColoradoCO
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Anthem Blue Cross and Blue Shield – KentuckyKY
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Anthem Blue Cross and Blue Shield in Virginia (PPO only; HMO Healthkeepers/Healthkeepers Plus must obtain in-network exception)VA
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Anthem Blue Cross and Blue Shield – ConnecticutCT
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Anthem Blue Cross and Blue Shield – IndianaIN
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Anthem Blue Cross and Blue Shield – MaineME
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Anthem Blue Cross and Blue Shield – MissouriMO
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Anthem Blue Cross and Blue Shield – New HampshireNH
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Anthem Blue Cross and Blue Shield – OhioOH
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Anthem Blue Cross and Blue Shield – WisconsinWI
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Anthem Blue Cross and Blue Shield in NevadaNV
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Anthem Blue Cross of CaliforniaCA
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Arise Health Plan/WPS Health InsuranceWI
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AultcareOH
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Avera Health Plans, Inc.SD
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Beacon HealthME
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Blue Cross and Blue Shield of IllinoisIL
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Blue Cross and Blue Shield of KansasKS
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Blue Cross and Blue Shield of Kansas CityKS, MO
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BlueCross BlueShield of Michigan and Blue Care Network of Michigan (JVHL BCN Participating Provider)MI
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BlueCross BlueShield of NebraskaNE
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Blue Cross & Blue Shield of MinnesotaMN
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Blue Cross Blue Shield of North DakotaND
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Blue Cross Blue Shield of TexasTX
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Blue Cross and Blue Shield of MontanaMT
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Blue Cross and Blue Shield of New MexicoNM
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Blue Cross Blue Shield of ArizonaAZ
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Blue Cross Blue Shield of WyomingWY
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Blue Cross & Blue Shield of FloridaFL
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Blue Cross and Blue Shield of Georgia, Inc. (PPO only; HMO/Open Access POS must obtain in-network exception)GA
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Blue Cross of IdahoID
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Blue Cross & Blue Shield of LouisianaLA
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Blue Cross & Blue Shield of MassachusettsMA
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BlueShield of Northeastern New YorkNY
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BlueCross BlueShield of Western New YorkNY
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Blue Cross & Blue Shield of Rhode IslandRI
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Blue Cross and Blue Shield of VermontVT
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Blue Shield of CaliforniaCA
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BlueCross BlueShield of AlabamaAL
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BlueCross BlueShield of North Carolina (Participates in the Avalon Healthcare Solution network of laboratories)NC
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BlueCross BlueShield of South Carolina (Participates in the Avalon Healthcare Solution network of laboratories)SC
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BlueCross BlueShield of TennesseeTN
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Bright Health PlanIL, OH, OK, NE, TX
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Bright Health PlanNY
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Bright Health PlanAZ, CA, CO, UT
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Bright Health PlanNC, TN, VA
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Bright Health PlanAL, FL, GA, SC
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Capital BlueCross (Participates in the Avalon Healthcare Solution network of laboratories)PA
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Capital District Physicians’ Health PlanNY
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Care N Care Health PlanTX
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CareFirst BlueCross BlueShieldDC, MD, VA
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CareSource IndianaIN
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Centene - Ambetter of TennesseeTN
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Centene - Ambetter of North Carolina Inc.NC
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Centene - Arizona Complete Health (Ambetter and Allwell)AZ
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Centene - Health Net of CA (Commercial Exchange and Medicare Advantage)CA
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Centene - IlliniCare (Ambetter and Allwell)IL
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Centene - MHS (Ambetter and Allwell)IN
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Centene - Sunflower Health Plan (Ambetter and Allwell)KS
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Centene - Buckeye Health Plan (Ambetter and Allwell)OH
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Centene - Superior Healthplan (Ambetter and Allwell)TX
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Centene - MHS Health Wisconsin (Allwell)WI
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Centene - Home State Health (Ambetter and Allwell)MO
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Centene - Arkansas Health & Wellness (Ambetter and Allwell)AR
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Centene - Coordinated Care (Ambetter and Allwell)WA
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Centene - Trillium Community Health Plan (Med Adv)OR
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Centene - Health Net Health Plan of Oregon (Med Adv)OR
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Centene - SilverSummit Health Plan (Ambetter)NV
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Centene - New Hampshire Health Families (Ambetter)NH
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Centene - PA Health & Wellness (Ambetter and Allwell)PA
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Centene - Sunshine Health (Ambetter and Allwell)FL
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Centene - Peach State Health Plan (Ambetter and Allwell)GA
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Centene - Louisiana Healthcare Connections (Allwell)LA
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Centene - Magnolia Health (Ambetter and Allwell)MS
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Centene - Absolute Total Care (Ambetter and Allwell)SC
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CignaNational
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Contra Costa Health PlanCA
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Common Ground Healthcare CooperativeWI
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ConnectiCare, Inc.MA, RI, NY, CT
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Coquille TribeOR
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Culinary Health FundNV
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Dean Health Plan/Prevea360 Health PlanWI
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EmblemHealthNY
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Empire BlueCross BlueShieldNY
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Excellus BlueCross BlueShieldNY
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Fallon Community Health PlanMA
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Fidelis CareNY
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FirstCarolinaCareNC
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Florida Health Care Plans, Inc.FL
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Gateway Health Plan – HealthChoices (Med Adv)PA
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Geisinger Health PlanPA
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Global HealthOK
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Group Health Cooperative Eau ClaireWI
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Group Health Cooperative of South Central WIWI
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Harvard Pilgrim Health PlanMA
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Health Alliance Medical Plans, Inc.IL
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Health Alliance Plan of MichiganMI
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Health First Health PlanFL
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Health Net Federal Services, LLC (TRICARE West Region)*AK, HI, WA, OR, CA, ID, NV, UT,CO, AZ, NM, MT, WY
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Health Net Federal Services, LLC (TRICARE West Region)*TX, KS, MO, IA, NE, NM, ND, SD
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Health New EnglandCT, MA
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Health Plan of NevadaNV
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HealthChoiceOK
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HealthfirstNY
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HealthPartnersMN, IA, WI
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Health Tradition Health PlanWI
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Healthsmart World Trade Center Health PlanNY
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Highmark Blue Cross and Blue ShieldPA, WV, DE
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HMSAHI
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Hometown HealthNV
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Horizon Blue Cross Blue Shield of New JerseyNJ
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HumanaNational
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IdealCare by Sendero Health PlansTX
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Independent Health AssociationNY
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Indiana University Health PlansIN
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Johns Hopkins Employer Health ProgramsMD
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Johns Hopkins US Family Health PlanMD
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Kaiser Foundation Health Plan of WashingtonID, WA
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Maine Community Health OptionsME
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McLarenMI
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Medica Health PlansMN, IA, KS, NE, ND, SD, WI
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Medical Associates Health PlanIA, IL, WI
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Medical Mutual of OhioOH
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MedStar Family ChoiceMD
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MercyCare Health PlanWI, IL
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MHS WisconsinWI
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Moda HealthOR
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Molina HealthcareCA, NM, WA, UT, ID
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Molina HealthcareNY
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Molina HealthcareFL
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Molina HealthcareMI, OH, TX, WI
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Mountain Health CO-OPID, MT
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MS State and School Employees' Health Insurance PlanMS
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Neighborhood Health Plan of Rhode IslandRI
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Network HealthWI
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New Mexico Health ConnectionsNM
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Ohio State University Health PlanOH
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Optima HealthVA
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Oscar Health InsuranceAZ, CA, CO
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Oscar Health InsuranceTN, VA, PA
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Oscar Health InsuranceKS, MO, MI, TX, OH
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Oscar Health InsuranceNY, NJ
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Oscar Health InsuranceFL, GA
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PacificSource Health PlansOR, ID, MT
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Partners Health PlanNY
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Physicians Health Plan of Northern IndianaIN
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Physicians Health PlanMI
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Piedmont Community Health PlanVA
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Preferred Health ChoiceIA, IL, WI
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Preferred OneMN
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Priority HealthMI
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Prominence Health PlanNV
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Prominence Health PlanTX
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Providence Health PlanOR
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Public Employees Health Plan (PEHP)UT
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Quad City Community HealthcareIA
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QuartzWI
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Regence BlueCross BlueShield of OregonOR
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Regence BlueCross BlueShield of UtahUT
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Regence BlueShield of IdahoID
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Regence BlueShield of WashingtonWA
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Rocky Mountain Health PlanCO
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Sanford Health PlanSD
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Scripps Health Plan ServicesCA
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SelectHealthID, NV, UT
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Sentara Health PlanVA
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Sierra Health and LifeNV
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Signature Care NetworkIN
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SummaCareOH
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Total HealthcareMI
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Tufts Health PlanMA, RI, NH
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United HealthcareNational
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United Medical Resources (UMR)National
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University of Utah Health PlansUT, ID
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Univera HealthcareNY
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UPMCPA
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US Family Health Plan of New YorkNY
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Virginia PremierVA
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WEA TrustWI
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Wellmark Blue Cross and Blue Shield of IowaIA
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Wellmark Blue Cross and Blue Shield of South DakotaSD
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In Network Plans - Medical Groups And IPAs
PayorState-
Access Medical Group (HMO)CA
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Affinity Medical Group (CA)CA
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Austin Regional Independent Associates (ARIA)TX
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Axminster Medical GroupCA
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Brown and Toland Physicians (HMO)CA
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California IPACA
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Central Valley Medical Providers (CA)CA
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Choice Medical GroupCA
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Community Care IPACA
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Dignity Health Medical Foundation - Mercy Medical GroupCA
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Dignity Health Medical Foundation - Woodland ClinicCA
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Dignity Health Medical Network – Central CaliforniaCA
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Dignity Health Medical Network - Inland EmpireCA
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Dignity Health Medical Network - Santa CruzCA
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Facey Medical Group (HMO)CA
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Hospital Sisters Health SystemIL
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Humboldt IPACA
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Illinois Physicians AllianceIL
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John Muir Health Physician NetworkCA
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Lakeside Medical Organization, a Medical Group, Inc.CA
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Medi Choice IPACA
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Meritage Medical Network (HMO)CA
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Methodist First ChoiceIL
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Monarch HealthcareCA
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NorthBay HealthcareCA
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OSF Healthcare SystemIL
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Palo Alto Medical FoundationCA
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Physicians Association of IllinoisIL
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Physicians Care NetworkIL
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Premier Care IPACA
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Progress HealthIL
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Regal Medical Group, Inc.CA
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SanSum Clinic (HMO)CA
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Santa Clara County IPACA
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Sante Medical Group (CA)CA
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Scripps Coastal Medical Center (CA)CA
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Scripps Coastal Medical Group (CA)CA
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Scripps Physician Medical Group (CA)CA
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Seoul Medical Group (HMO)CA
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Sinai Medical GroupIL
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St. John's Health CenterCA
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Sutter East Bay Medical FoundationCA
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Sutter Gould Medical FoundationCA
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Sutter Independent PhysiciansCA
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Sutter Medical FoundationCA
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Sutter Pacific Medical FoundationCA
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Swedish Covenant Physician PartnersIL
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Torrance Health IPACA
* TRICARE is a registered trademark of the Department of Defense, Defense Health Agency. All rights reserved
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Last updated January 2023.
Exact Sciences Patient Assistance Program
We believe everyone should have access to the best healthcare options. Our patient assistance program helps patients facing challenges with insurance coverage receive their Cologuard screening at no cost.
If you face these challenges and Cologuard is right for you, you may receive screening 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.†‡
If you apply to receive no-cost Cologuard screening, you'll be asked to provide income documentation. If you qualify for other assistance programs, that may be enough to determine you are eligible for our program.§
Those programs include, but are not limited to:
- Medicaid†
- Supplemental Nutrition Assistance Program (SNAP)
- Supplemental Security Income (SSI)
- Home Energy Assistance Program
Have questions about our assistance program? Interested in applying? Please call our Customer Care Center at 1-844-870-8870 (select "billing option").
* 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.
† FPL is based on the thresholds for the 48 contiguous states and the District of Columbia
‡ Some state programs assign a small copay for Cologuard
§ Exact Sciences makes a determination of patient assistance in good faith based on an individualized assessment of financial need.
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.