These are not the same rules that apply to other health plans.
Colonoscopies are one of the most common screening tests forcolorectal cancer.
Be sure to check with your supplemental coverage to see how this works.
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That used to be the case for diagnostic colonoscopies too.
The rate was decreased to 15% for this procedure, and only this procedure, in 2023.
It will drop to 10% in 2027, and then to 0% in 2030 and beyond.
At that point, there will be no out-of-pocket costs for diagnostic colonoscopies covered by Medicare.
Screening Colonoscopy Turned Diagnostic
Imagine you are scheduled for a screening colonoscopy.
During the procedure, your doctor finds a polyp.
Since it was scheduled as a screening test, you would expect the test to be free.
Medicare will cover the test, but it will no longer be free.
You will pay a 15% Part B coinsurance.
In this case, however, the Part B deductible does not apply.
Keep in mind, ABNs apply only to Original Medicare, not to Medicare Advantage plans.
Frequency of Colonoscopy Screening
How often Medicare pays for screening depends on your risk.
For people considered high risk, a screening colonoscopy can be performed every 24 months.
To be clear, this is not based on the calendar year but on actual months.
If your last colonoscopy was 23 months ago, Medicare will not cover it as a free screening test.
This does not mean Medicare wont cover the test more frequently.
You will be expected to pay the Part B coinsurance after paying down your annual deductible.
That follow-up colonoscopy will be considered diagnostic, since it will not be on the 10-year screening schedule.
In addition, diagnostic colonoscopies are performed when someone has signs and symptoms.
Summary
As a screening tool for colorectal cancer, colonoscopies set the standard.
They allow your doctor to visualize the colon and to take action if they see any abnormalities.
Medicare covers screening colonoscopies for free in most cases.
This fee will be reduced to 10% in 2027, and eliminated altogether by 2030.
Most Medicare beneficiaries have supplemental coverage that will pay the coinsurance associated with polyps found during screening colonoscopies.
2022;387(17):1547-1556. doi:10.1056/nejmoa2208375
KFF.org.A Snapshot of Sources of Coverage Among Medicare Beneficiaries.
Sep. 23, 2024.
healthinsurance.org.What is the ACAs preventive health services coverage mandate?
