Private Insurance Plans Must Cover the Full Colorectal Cancer Screening Continuum


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November 1, 2022, Update

HHS Finalizes Physician Payment Rule Strengthening Access to Behavioral Health Services and Whole-Person Care

On November 1, the Centers for Medicare and Medicaid Services (CMS) finalized a proposed rule to ensure Medicare beneficiaries won’t face out-of-pocket costs if they need a colonoscopy after getting a positive result on a noninvasive colorectal cancer screening test.

You made this happen! 192 advocates reached out to CMS urging them to finalize this rule and they listened.

Noninvasive screening tests, such as FIT or Cologuard® are great options for average-risk patients to complete colorectal cancer screening. But for those who receive a positive result, screening is not complete until they undergo a colonoscopy. Ensuring that cost is not a barrier will help increase access to colorectal cancer screening and ultimately save lives! 

This proposed rule builds on the advocacy win we had earlier this year when the federal government released guidance directing commercial insurance plans to cover, without cost to the patient, a colonoscopy after a positive noninvasive screening test.

AGA, American Cancer Society Cancer Action Network and Fight Colorectal Cancer (CRC) urged regulators to eliminate out-of-pocket costs for patients that remain barriers to screening. 

On Jan. 10, 2022, the Biden Administration issued guidance requiring private insurers to cover colonoscopy when needed as a follow-up to a non-invasive colorectal cancer screening test. This will prevent patients from receiving surprise bills for a colonoscopy when they receive a positive result from a stool-based test.  

Representatives of AGA, American Cancer Society, American Cancer Society Cancer Action Network and Fight CRC worked together to urge the Administration to make this change, including last fall meeting with regulators from the U.S. Departments of Labor, Health and Human Services, and Treasury, (which together regulate private insurance plans under the Affordable Care Act) to request they provide direction to private health plans.  We applaud the Administration for supporting coverage of the full colorectal cancer screening continuum, which will improve access to life-saving screening. 

“Now patients can choose the best colorectal cancer screening test for them without fear of a surprise bill. Patients have full coverage of the full screening continuum—from an initial stool or endoscopic test to a follow-up colonoscopy. Now that the financial barriers have been eliminated, we can focus on increasing screening so we can prevent cancer deaths,” says John Inadomi, MD, president of the AGA.   

The coverage guidance expands on the requirement that plans start providing the screening benefit to patients age 45+ for plan or policy years beginning on or after May 31, 2022.  For health insurance plans that have already been implemented, patients need to check with their insurance provider as they may not include this coverage until next year. 

“Ensuring individuals have access to this lifesaving screening will significantly reduce suffering and death from this disease,” said Lisa Lacasse, president of the American Cancer Society Cancer Action Network (ACS CAN). “This year alone, the American Cancer Society estimates more than 150,000 individuals will be diagnosed with colorectal cancer and more than 52,000 will die from the disease. But colorectal cancer is preventable when pre-cancerous polyps are found and removed through a colonoscopy. The announcement from the Tri-Agencies clarifying all private insurance plans must fully cover colonoscopies after a positive non-invasive stool test will save lives from colon cancer. ACS CAN will work to expand this coverage to traditional Medicare and Medicaid beneficiaries to help ensure all individuals who need a colonoscopy are able to access one.” 

"Non-invasive colorectal cancer screening tests are an important tool in the fight against colorectal cancer, particularly in light of challenges patients have faced due to COVID-19, and as we expand our efforts to reach medically underserved communities,” says Anjee Davis, MPPA, president of Fight Colorectal Cancer.” This guidance will help ensure that patients can choose the test that is best for them without worrying about out-of-pocket costs. Ultimately this will save lives and support early detection of colorectal cancer." 

Colorectal cancer remains the second leading cancer killer in the United States despite the availability of preventive screening options. In 2018, just 68.8% of those eligible were screened for colorectal cancer. The challenge of getting people screened was exacerbated in 2020, when it is estimated that colorectal cancer screening declined by 86% during the first few months of the COVID-19 pandemic.  

8 thoughts on “Private Insurance Plans Must Cover the Full Colorectal Cancer Screening Continuum

  1. I had a positive Cologuard. I would like a screening colonoscopy. I had different insurance for the Cologuard than I have now. Will my new insurance look up my previous Cologuard results?

    1. Hi Erin, It is a good idea to call your insurer to confirm they will cover your colonoscopy.

      Cologuard® provides assistance to help patients navigate the process with your insurance company. Please call the Cologuard patient support line at 844-870-8870. Cologuard will connect you with someone who will assist you in navigating through your insurance issues.

  2. I am 63. I previously had Kaiser Permanente insurance and they scheduled a no cost colonoscopy evey 5 years since I was 42 because of my family history of Colon cancer. Each time the doc would find 1 to 3 polyps. Now, my new carrier Blue Shield of California is refusing to cover a colonoscopy as “preventative”. No coverage means no colonoscopy. I cannot afford a $2500 co-insurnace. What should I do?

    1. Hi Gary,

      Unfortunately currently there isn’t any federal coverage requirements for surveillance colonoscopies. It can really vary based on your insurance. Our best advice is to appeal to your insurers and see if they can get their doctors on board to help in that process.

    1. Hi Ernesto: Thank you for your comment.

      Insurance coverage varies, and depends on your plan. Please reach out to and speak with your insurance provider to best understand what your out-of-pocket costs will be.

  3. My insurance company, Blue Cross Blue Shield of Illinois is refusing to cover my colonoscopy as “preventative” following a positive Cologuard test at age 45. What can you do to help me?

    1. Hi Kelly,

      I just received your comment on our site.

      Cologuard® provides assistance to help patients navigate the process with your insurance company.

      Please call the Cologuard patient support line at 844-870-8870. Cologuard will connect you with someone who will assist you in navigating through your insurance issues.

      You can also call your insurance company.

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