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Dear Connie,
I’m 70 and haven’t had a colon cancer screening. A colonoscopy scares me. I’ve heard about Cologuard, a test you can do at home. Does Medicare cover Cologuard?
Wondering about my options,
John from Georgetown, Texas
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Dear John,
We’re glad you’re looking into colon cancer screening options. You’ve come to the right place for answers. Good news, Medicare cologuard coverage is available for people who qualify.
Colorectal cancer is the third most common cancer in the United States. The American Cancer Society estimates that in 2026, there will be about 108,860 new cases of colon cancer and nearly 49,990 new cases of rectal cancer. That’s why early detection is so important, especially as we get older.
The U.S. Preventive Services Task Force recommends that all adults ages 45 to 75 get screened for colorectal cancer. Since you’re 70 and haven’t been screened yet, now is a good time to schedule your screening.
Agent tip:
“Original Medicare and Medicare Advantage plans cover the Cologuard test once every 36 months. You must meet specific criteria to qualify. Cologuard is the only at-home stool DNA test covered by Medicare.”
Some people have a higher risk of colon cancer than others. If any of these apply to you, talk with your doctor about a screening plan that fits your needs.
You are at increased risk if you:
You are at high risk if you:
If you have an increased risk or are at high risk, talk to your doctor. They can help you decide when to start screening, which test is right for you, and how often you should be screened.
There are two main types of colon cancer screening tests. Stool-based tests check your stool for signs of cancer. Visual exams let your doctor look inside your colon and rectum.
These tests need to be done at different times. Stool-based tests are typically performed more frequently than visual exams.
If your stool-based test comes back positive, you will need a colonoscopy to complete your screening. Consult your doctor to determine which test is best for you.
Cologuard is a multi-target stool DNA test. It checks your stool sample to see if colorectal cancer might be present. Unlike a colonoscopy, you don’t need to go to a doctor’s office or hospital. Cologuard was FDA-approved in August 2014, making it the first stool DNA test cleared for colorectal cancer screening.
Cologuard is best for people at average risk of colorectal cancer. It is not meant for people at increased or high risk. It also does not replace a colonoscopy. Cologuard is made by Exact Sciences Corporation, a company that specializes in cancer detection tests.
In October 2014, the Centers for Medicare and Medicaid Services (CMS) decided that Original Medicare Part B would cover the Cologuard test. Medicare covers it once every 36 months if you meet certain requirements.
Here’s how it works. You collect a stool sample at home and send it to a lab. The lab tests the sample for blood and certain DNA changes. The test can also detect DNA markers that indicate whether polyps have formed in your digestive tract.
Cologuard is quite accurate at finding colorectal cancer. According to Exact Sciences, clinical studies show it detected 92% of colorectal cancers and 42% of precancerous polyps. If your test result is negative, Medicare will continue to cover repeat Cologuard screening every 36 months as long as you remain at average risk and have no symptoms.
However, Cologuard can sometimes return a false positive. This means the test shows a possible problem when there isn’t one. If your result is positive, your doctor will recommend a follow-up colonoscopy to confirm the result.
To qualify for Medicare coverage of Cologuard, you must meet these criteria:
Colon cancer screening is a covered preventive service under Medicare Part B. Medicare coverage for the Cologuard stool DNA test is established in federal law through the Social Security Act, which outlines the preventive screening services Medicare must provide. Because Cologuard is an approved colorectal cancer screening option, eligible Medicare beneficiaries can receive the test at no cost, provided they meet the coverage requirements.
Medicare Advantage (Part C) plans must offer at least the same preventive benefits as Original Medicare. This means Medicare Advantage plans, offered by private insurance companies, also cover Cologuard and other colorectal cancer screening tests at no cost when the screening is medically appropriate and coverage guidelines are met.
Medicare covers Cologuard once every 36 months for eligible individuals. This at-home test is a good option if you’re at average risk for colon cancer and want to avoid a colonoscopy. Remember, if your Cologuard test is positive, you will need a follow-up colonoscopy.
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M-F 9am - 5pm
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Yes, Medicare Part B covers Cologuard at $0 when you meet all eligibility requirements. You must be ages 50 to 85, have no symptoms, and be at average risk. If you have a Medicare Advantage plan, Cologuard is also covered at $0, but confirm with your plan before ordering the test.
Cologuard is a stool DNA test you do at home and mail to a lab. A colonoscopy is a visual exam done at a facility under sedation. Cologuard is less invasive, but a colonoscopy is more thorough; it can detect and remove polyps during the same procedure.
A positive test result does not mean you have cancer. It indicates that something was detected that requires follow-up. Your doctor will likely order a diagnostic colonoscopy to get a clearer picture.
Possibly. A follow-up colonoscopy after a positive Cologuard result is considered diagnostic, not preventive, which means standard Medicare cost sharing may apply. Under Original Medicare, you may be responsible for the Part B deductible and 20% coinsurance. Costs vary by Medicare Advantage plan, so check your plan details.
No. Medicare only covers Cologuard for people at average risk. If you have a family history of colon cancer or polyps, you are considered at increased risk and will need a different screening, such as a colonoscopy. Talk to your doctor about the right option for you.
Read more by Jasmine Alberto
I am a Spanish-speaking Texas Life and Health Insurance Licensed Agent and have been helping people with Medicare since 2007. I am on the the Advisory Committee for Foster Grandparents, Senior Companions, and RSVP Houston. I enjoy traveling, a backyard BBQ, and volunteering in my community.
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