Quick Answer
Yes, Medicare covers Cologuard as a colorectal cancer screening test for eligible beneficiaries age 45–75 who are at average risk for colorectal cancer. Cologuard is covered at $0 cost under Medicare's preventive services benefit - once every 3 years. If you are at high risk or have symptoms, a colonoscopy is typically recommended instead.
Coverage Comparison by Plan Type
| Plan Type | Coverage | Notes |
|---|---|---|
| Medicare Part B (Preventive) | Covered at $0 | Covered as a preventive screening for average-risk beneficiaries ages 45–75; once every 3 years |
| Medicare Advantage (Part C) | Covered | Must cover same preventive services as Original Medicare; $0 cost for in-network preventive care |
| Medicare Supplement (Medigap) | Not Needed | Cologuard is $0 under Medicare preventive benefits; Medigap not needed for this service |
| Medicare Part D | Not Applicable | Cologuard is a lab test, not a prescription drug; not covered under Part D |
Understanding Your Coverage Options
Original Medicare (Part B)
Covered - $0 for eligible beneficiariesMedicare Part B covers Cologuard as a preventive colorectal cancer screening test. Cologuard is a multitarget stool DNA (mt-sDNA) test that can be completed at home - you collect a stool sample and mail it to a lab for analysis. No bowel prep or sedation is required.
Medicare covers Cologuard at **$0 cost** (no deductible, no coinsurance) for beneficiaries who meet the eligibility criteria. The test is covered once every 3 years. If your Cologuard result is positive, Medicare will cover a follow-up colonoscopy at $0 as well - because the colonoscopy is considered a continuation of the screening process.
**Important:** If you have symptoms of colorectal cancer (rectal bleeding, unexplained weight loss, changes in bowel habits), Medicare will not cover Cologuard as a preventive screening. Instead, your doctor will order a diagnostic colonoscopy, which is covered under different rules.
What It Covers
- Cologuard test kit and lab analysis (at $0 for eligible beneficiaries)
- Follow-up colonoscopy after a positive Cologuard result (at $0)
- One test every 3 years for average-risk beneficiaries ages 45–75
What It Doesn't Cover
- Cologuard for high-risk beneficiaries (colonoscopy is recommended instead)
- Cologuard when ordered for diagnostic (not screening) purposes
- More frequent testing than once every 3 years under the preventive benefit
Cologuard is covered at $0 under Medicare's preventive services benefit. No deductible or coinsurance applies when ordered as a preventive screening.
Medicare Advantage (Part C)
Covered - $0 for in-network preventive careMedicare Advantage plans are required by law to cover all Medicare preventive services at $0 cost when you use in-network providers. Cologuard is a Medicare-covered preventive service, so it is covered at $0 by all Medicare Advantage plans for eligible beneficiaries.
Some Medicare Advantage plans may have additional colorectal cancer screening benefits beyond what Original Medicare requires. Check your plan's Evidence of Coverage for details.
What It Covers
- Cologuard at $0 for eligible beneficiaries (in-network)
- Follow-up colonoscopy after a positive Cologuard result
- All Medicare preventive colorectal cancer screenings
What It Doesn't Cover
- Out-of-network Cologuard orders (may result in cost-sharing)
- Cologuard ordered for diagnostic purposes (different cost-sharing applies)
Covered at $0 for in-network preventive care. Costs may apply if ordered out-of-network or for diagnostic purposes.
Confirm Your Ordering Provider is In-network
To ensure $0 cost for Cologuard under Medicare Advantage, confirm that the doctor ordering the test is in your plan's network. Out-of-network orders may result in cost-sharing.
Medicare Supplement (Medigap)
Cologuard is already $0 under MedicareBecause Cologuard is covered at $0 under Medicare's preventive services benefit, Medigap plans are not needed for this specific service. There is no coinsurance or deductible for Medigap to cover.
However, if your Cologuard result is positive and you need a follow-up colonoscopy, Medigap can help cover any cost-sharing that applies to that procedure. And if you need a diagnostic colonoscopy (due to symptoms), Medigap would cover the 20% Part B coinsurance.
What It Covers
- Part B coinsurance for diagnostic colonoscopy following a positive Cologuard result
- Any cost-sharing for related follow-up procedures
What It Doesn't Cover
- Cologuard itself - it's already $0 under Medicare preventive benefits
No Medigap cost-sharing applies to preventive Cologuard. Medigap is valuable for follow-up diagnostic procedures if your Cologuard result is positive.
Cologuard vs. Colonoscopy: Medicare Coverage Comparison
| Test | Frequency | Preparation | Medicare Coverage | Your Cost |
|---|---|---|---|---|
| Cologuard (mt-sDNA) | Every 3 years | No prep required - at-home stool sample | Part B preventive benefit | $0 |
| Colonoscopy (screening) | Every 10 years (average risk) | Bowel prep + sedation required | Part B preventive benefit | $0 |
| Colonoscopy (high risk) | Every 2 years | Bowel prep + sedation required | Part B preventive benefit | $0 |
| Colonoscopy (diagnostic) | As needed | Bowel prep + sedation required | Part B (not preventive) | 20% coinsurance after deductible |
| Follow-up colonoscopy (after positive Cologuard) | As needed | Bowel prep + sedation required | Part B preventive benefit | $0 |
✦ Cologuard Coverage Rules and Exceptions
Age and Risk Eligibility
Medicare covers Cologuard for beneficiaries ages 45–75 who are at average risk for colorectal cancer. 'Average risk' means no personal or family history of colorectal cancer or polyps, no inflammatory bowel disease, and no symptoms of colorectal cancer.
Frequency Limit
Medicare covers Cologuard once every 3 years. If you order Cologuard more frequently, you may be responsible for the full cost. A colonoscopy is covered more frequently for high-risk beneficiaries.
Positive Result Follow-Up
If your Cologuard result is positive, Medicare covers a follow-up colonoscopy at $0 - because CMS considers the colonoscopy a continuation of the colorectal cancer screening process, not a separate diagnostic procedure.
Symptoms Change Coverage
If you have symptoms of colorectal cancer (rectal bleeding, unexplained weight loss, changes in bowel habits), Cologuard is not appropriate as a screening test. Your doctor will order a diagnostic colonoscopy, which is covered under different rules with standard Part B cost-sharing.
✦ Frequently Asked Questions
David Haass
AuthorDavid Haass is the Chief Technology Officer and Co-Founder of Elite Insurance Partners and MedicareFAQ.com. He is a member and regular contributor to Forbes Finance Council.
Ashlee Zareczny
ReviewerAshlee Zareczny is a licensed Medicare agent in all 50 states dedicated to educating those eligible for Medicare. She trains agents on CMS compliance guidelines.