Most Health Insurance Plans Now Cover Colonoscopy Procedures

Many patients getting screened for colorectal cancer (CRC) may not have to pay out of pocket for a follow-up colonoscopy to evaluate a positive, non-invasive CRC screening test.

New federal guidance requires health insurance plans to fully cover the cost of a follow-up colonoscopy to evaluate a positive result from an MTs-DNA stool-based test (Cologuard) as well as a fecal immunochemical test (FIT).

“Ensuring individuals have access to this lifesaving screening will significantly reduce suffering and death from this disease,” said Lisa Lacasse, president of the American Cancer Society Cancer Action Network.

It is important to understand that if your FIT or Cologuard test comes back positive for colon cancer, a follow-up colonoscopy is critical for your health. You are twice as likely to develop more advanced colon cancer if you skip this follow-up procedure.

New Insurance Guidance will Benefit Patients

In the past, the cost has been a significant barrier to many people, making it a primary reason not to get a follow-up colonoscopy. This new follow-up screening coverage is for plan or policy years beginning on or after May 31, 2022. Patients need to check with their insurance provider about this coverage.

This guidance will help ensure that patients can choose the test that is best for them without worrying about out-of-pocket costs. The ultimate goal is to save lives and support early detection of colorectal cancer.