Medicare benefits cover a variety of colorectal cancer screening tests, including fecal occult blood tests (FOBTs), sigmoidoscopies, colonoscopies, and barium enemas. The screening tests are covered under Medicare Part B. In general, there's no charge (no deductible and no copay) for an FOBT; for the other three tests, a coinsurance or copay applies after you've met the yearly Medicare Part B deductible.
The type of coverage differs depending on whether your risk of developing colorectal cancer is considered high or average. In general, the following risk factors would place you in the high risk category:
- A sibling, parent, or child who has had colorectal cancer or polyps,
- A family history of hereditary non-polyposis colorectal cancer (HNPCC), or
- A personal history of colorectal polyps, colorectal cancer, or inflammatory bowel disease (IBD).
Medicare Benefits for Average Risk Individuals
If you're 50 or older, Medicare benefits will cover one FOBT each year, one sigmoidoscopy every four years, one colonoscopy every ten years, or one barium enema every four years. In general, your Medicare benefits won't cover a screening test until the results of your last screening test expire. For example, since colonoscopy results are good for ten years, Medicare won't pay for another screening test until 119 months have passed since your last colonoscopy (or 47 months since your last sigmoidoscopy or 11 months since your last FOBT or barium enema).Medicare Benefits for High-Risk Individuals
Regardless of your age, your Medicare benefits will cover one FOBT each year if you're considered at high risk for developing colorectal cancer. If you're 50 or older, your Medicare benefits will cover one sigmoidoscopy every four years, one colonoscopy every two years, or one barium enema every two years. Medicare still imposes wait times, but they're shorter if you're in the high-risk category. In general, you still have to wait 47 months before your next sigmoidoscopy is covered, but your Medicare benefits will cover another colonoscopy or barium enema within 23 months of the last one.This article is intended to provide an overview of Medicare benefits for colorectal cancer screening. For more details (15 pages worth!), you may want to read the Colorectal Cancer Screening excerpt from the Guide to Medicare Preventive Services. It's very detailed and is not intended as a guide for patients. (It was written for health care professionals.) If you have questions, you may want to print it out and take it to your doctor before scheduling a procedure to make sure it will be covered.
For more information regarding colorectal cancer screening tests, please refer to the Colorectal Cancer Screening section of this site. If you're having trouble convincing a loved one to get screened for colorectal cancer, you may want to read one of the articles that provides tips on how to get someone you love to get screened.
Source: Health and Human Services. The Guide to Medicare Preventive Services for Physicians, Providers, Suppliers, and other Health Care Professionals.
