Cologuard^®
and insurance

Understanding what is covered by your plan can be very complex. It can vary based on your insurer’s medical policy, your specific benefits, deductibles and amounts you may have already incurred against a deductible, and other factors. The best way to find out is to call your insurer directly, but here is some information as of March 2021 about major plans and relevant state laws:

• People with Medicare Part B¹ may receive a bill for a follow-up colonoscopy that includes co-insurance (typically 20%) and the deductible.
• People with Medicare Advantage may receive a bill for a follow-up colonoscopy that includes co-insurance (in varying amounts, depending on the plan) and a deductible.
• According to their posted medical policies, UnitedHealthcare², UPMC Health Plan³, BlueCross and BlueShield of Vermont⁴ and other payers generally cover a follow-up colonoscopy at no out-of-pocket cost to the patient.
• Kentucky⁵, Oregon⁶, Texas⁷, Rhode Island⁸, Arkansas⁹, and California¹⁰ have enacted state laws that require some plans in those states to cover follow-up colonoscopies at no out-of-pocket cost to the patient.
• Illinois¹¹ enacted a state law that requires some plans to cover follow-up colonoscopies at no out-of-pocket cost to the patient. High-deductible health plans are excluded from this law and patients with a high-deductible plan may be subject to out-of-pocket costs for a follow-up colonoscopy.

The Affordable Care Act requires insurers to cover colon cancer screening at no cost to the patient. We believe that a follow-up colonoscopy after a positive screening result is part of the screening process, and it should also be covered at no cost to the patient. If you receive a bill for a follow-up 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.