INSURANCE COVERAGE AND COST
Get screened for colon cancer for $0*
Cologuard® is included on a wide range of insurance plans for eligible patients. Coverage can vary, check your insurance and which test is covered today.
Most insured patients pay $0*
A large number of national and regional insurers already pay for colon cancer screening. We’re committed to working with insurance companies to expand coverage and access for patients aged 45 and above.
Let’s check your insurance
Medicare
The Cologuard Plus test is available with no copay or deductible for eligible Medicare Part B members aged 45 to 85. If you have a Medicare Advantage plan, use the search tool below to see if you’re eligible to receive the Cologuard Plus test.*
Medicaid
The Cologuard Plus test is available to eligible patients enrolled in a growing number of state Medicaid programs. No payment is expected unless the plan requires a copay.* Use the search tool below to see if your Medicaid plan provides access to the Cologuard Plus test.*
Search insurance providers
Use the search tool below to find your insurance provider and see which test is available. A limited number of patients may receive the original Cologuard test from their insurer.
Insurance provider not found
Sorry, but your insurance may be out of network. Please call 1-866-267-2322 (Billing Enterprise) for assistance.
Have questions about your access to the Cologuard Plus test? Don’t see your plan listed? Customer Care is ready to provide answers at 1-844-870-8870.
What in-network means
Simply put, it means that we’ve agreed with your insurer to be part of their lab network. Your health plan will then cover the cost of your test if you meet certain clinical criteria.
Exact Sciences cannot guarantee a patient’s insurance coverage or eligibility.† Some insurers have coverage and network limitations and exclusions. To be sure, please call your insurance provider to confirm:
- What they will pay
- What they expect you to pay
- Any required paperwork before using the test
The good news is, for eligible out-of-network patients aged 45-75, the Cologuard Plus test should be covered without a copay or deductible through the Affordable Care Act.
† 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. Our patient assistance program can help people who are facing challenges with their insurance coverage.
If your household is at or below 400 percent of the Federal Poverty Level (FPL), you might be able to request a Cologuard Plus test at no cost.1,2
You’ll be asked to provide income documentation. If you qualify for other assistance programs, that may be enough to decide your eligibility for our program.3
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 would like to apply? Please call our Customer Care Center at 1-844-870-8870 and select “billing option”.
Frequently asked questions
The Cologuard Plus test is the latest advancement in Cologuard testing. It includes optimized biomarkers resulting in increased performance in colorectal cancer and precancer detection over the current on-market Cologuard test. (The Cologuard Plus test was shown to detect 95% of colon cancers, compared to the 92% detection rate of our original Cologuard test.1)
Both tests are FDA-approved and are covered by Medicare Part B. Patients whose insurance plans do not yet cover Cologuard Plus may be prescribed the original Cologuard test.
Across the country, Cologuard is covered by different insurance plans. Insured patients often have no out-of-pocket cost for screening. Most insured patients pay $0.*
Patients whose insurance plans do not yet cover Cologuard Plus may be prescribed the original Cologuard test.
* Exact Sciences estimate based on historical patient billing. Rate of coverage varies by state and region. A limited number of patients may receive the original Cologuard test from their insurer. Exceptions for coverage may apply; only your insurer can confirm how Cologuard would be covered.
Medicaid
The Cologuard Plus test is available to eligible patients enrolled in a growing number of state Medicaid programs. No payment is expected unless your plan requires a copay.* Use our search tool to see if your Medicaid plan provides access.
Medicare
The Cologuard Plus test is available with no copay or deductible for eligible Medicare Part B members aged 45 to 85. If you have a Medicare Advantage plan, use our search tool to see if you’re eligible.
* Exact Sciences estimate based on historical patient billing. Rate of coverage varies by state and region. A limited number of patients may receive the original Cologuard test from their insurer. Exceptions for coverage may apply; only your insurer can confirm how Cologuard would be covered.
The self-pay price for the Cologuard Plus test is $599. This cost is eligible for reimbursement through FSA, HSA, or HRA accounts.