Colon / Colorectal
Get your colonoscopy fully covered
Last reviewed July 1, 2026
Screening colonoscopies for adults 45-75 are covered at 100% under the ACA — no copay, no coinsurance, no deductible. This includes the polypectomy (polyp removal) if one is found during the same procedure. That last part matters, because it used to be a huge billing loophole where a "screening" colonoscopy turned into "diagnostic" the moment they removed a polyp, and patients got surprise bills. That loophole was closed in 2022.
The steps
Confirm three things when scheduling: (1) you’re booking a screening colonoscopy, (2) you’re within the covered age range (45-75, or earlier with risk factors), (3) the facility and anesthesia providers are in-network. The colonoscopy itself is 100% covered, but anesthesia and pathology can be out-of-network at an in-network facility. This is the classic surprise bill. Ask specifically: "Are the anesthesiologist and the pathology lab in my network?"
If a polyp is found and removed during your screening colonoscopy, this is still covered as screening under current federal rules. If you get billed for the polypectomy separately — that’s a coding error and you appeal it.
This applies when
- You have ACA-compliant insurance
- You’re 45-75 and this is your routine screening (10-year interval)
- You’re under 45 but have family history or genetic risk (start earlier)
- You have Medicare (screening colonoscopy covered every 10 years, or every 24 months if high-risk)
This doesn't apply when
- You have symptoms (bleeding, bowel changes) — that’s diagnostic
- You’re getting a follow-up colonoscopy after a positive stool test (this SHOULD be covered under 2022 rules, but plans sometimes misapply — appeal if billed)
- You’re getting a shorter-interval colonoscopy because of previous polyps. This may be diagnostic depending on plan
Resources
ColonoscopyAssist (colonoscopyassist.com): Reduced-cost colonoscopies for people without insurance ($1,075-$1,595 depending on region. A fraction of retail price).
Colorectal Cancer Alliance Blue Star Program: Financial assistance and coordination for people who qualify. 1-877-422-2030 or ccalliance.org.
FIT (fecal immunochemical test) as a screening alternative: Under $30 retail, covered as screening under ACA. Not a replacement for colonoscopy long-term, but a valid annual screening.
Cologuard (stool DNA test): Covered under ACA for average-risk adults 45+, once every 3 years. Not for high-risk patients. Positive result requires follow-up colonoscopy.
If you're denied
If you get a bill for a screening colonoscopy, even after a polyp removal — call your insurer and cite the 2022 federal rule (Section 2713 clarification, effective 2022) that requires follow-up services during a screening colonoscopy to be covered at 100%. Get the claim reprocessed. If they refuse, appeal in writing. If that fails, complaint to state insurance commissioner.
