Cost of a Colonoscopy With Medicare
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|Average cost of a colonoscopy
On average, a colonoscopy costs an average of $3,081 without health insurance. Fortunately, Medicare can cover the cost of colonoscopy screenings if you’re at high risk for colorectal cancer or other cancers.
In this hypothetical, let’s say Mary needs a colonoscopy and Medicare will be paying for most of the cost — with the exception of additional services such as the removal of a tumor or polyp. Because she needs a polyp and a lesion removed, she will have to pay 20 percent of the cost of these additional services. Medicare will cover 80 percent of the Medicare-approved amount for the colonoscopy and hospital stay fees, including anesthesia, which is covered by Medicare Part B.
Under Medicare’s procedure price lookup tool, Mary finds that she will need to pay on average $258 in out-out-pocket costs for hospital outpatient departments. The Medicare-approved amount that will be paid by Medicare will be $1,035 of the $1,293 total cost (this includes the doctor fee and facility fee). Fortunately, the yearly deductible does not have to be met for Medicare coverage to kick in to cover the colonoscopy and hospital stay. However, this doesn’t include the cost of other out-of-pocket costs such as aftercare following a colonoscopy, which might not be covered by Medicare or her plan.
Medicare Advantage and Colonoscopies
Medicare Advantage operates through private insurance companies. Plans may vary, so it’s best to reach out to your Medicare Advantage plan to see whether copays, deductibles, and other out-of-pocket costs are required. In general, Medicare will pay for patients who are at high risk for colorectal cancer or have a family history or other criteria that their physician can attest to.
Although Medicare can pay for the full cost of a colonoscopy provided certain criteria are met, there are exceptions. For instance, if there’s other tissue or a polyp that needs to be removed during a colonoscopy, the patient would be responsible for 20 percent of the cost, while Medicare would take care of the remaining 80 percent.
Medigap and Colonoscopies
Medicare supplement plans such as Medigap can help cover colonoscopies and other out-of-pocket costs. Fortunately, you don’t have to meet the deductible for Medicare Part B. The exception is if polyps or other tissue must be removed; then you’d be responsible for paying additional costs since it’s not covered by Medicare. It’s best to contact your Medigap plan first if your physician suspects that additional tissues may need to be removed, in addition to the colonoscopy, as these services may not be fully covered.