Does Cigna Medicare Cover Colonoscopy?

In this article...
  • Colonoscopies help prevent colorectal cancer and diagnose the disease promptly. Find out if Cigna Medicare covers colonoscopy and who is eligible for testing.

A colonoscopy is a diagnostic procedure often used to detect colorectal cancer. The test involves inserting a flexible tube inside the colon to check for signs of cancer.

Regular screening for colorectal cancer can help prevent the disease from developing and allow you to access prompt treatment if the test is positive. Therefore, the U.S. Preventive Services Task Force recommends that people between 45 and 75 undergo regular screening. Knowing if your Cigna Medicare policy covers colonoscopy can help you save money on the cost of this essential preventive service. 

Does Cigna Medicare Cover Colonoscopy?

Generally, Cigna Medicare policies cover colonoscopy if you're eligible. Adults over 45 with an average risk of developing colorectal cancer receive coverage for a diagnostic colonoscopy every 10 years or a computed tomographic colonoscopy every 5 years. 

Cigna Medicare plans also cover several other colorectal cancer screening tests for enrollees aged 45 and over, including:

  • Yearly fecal occult blood or immunochemical tests
  • Barium enemas and flexible and flexible sigmoidoscopies every 5 years
  • Fecal DNA tests every 1 to 3 years

Who Is Eligible for Cigna Medicare Colonoscopy Coverage?

Although Cigna Medicare policies generally restrict how often you can have a covered colonoscopy, your plan may cover more regular screening if it's medically necessary. Generally, Cigna considers more regular screening essential if you have a personal or family history of colorectal cancer or an inflammatory bowel condition like Crohn's disease. 

You may also be entitled to more regular colonoscopy coverage through Cigna if you have an increased risk of developing colorectal cancer for other reasons. For example, you may require regular surveillance if a doctor diagnosed adenoma or adenomatous polyps during a previous colonoscopy or if a close family member has a similar diagnosis. 

Does Cigna Medicare Cover Anesthesia for Colonoscopies?

Until relatively recently, many healthcare insurers imposed cost sharing for anesthesia services during a covered colonoscopy. Most people require anesthesia during the procedure, so many enrollees had to shoulder significant costs to access appropriate pain relief.

However, the Centers for Medicare and Medicaid Services (CMS) clarified in 2015 that all insurance plans complying with the Affordable Care Act (ACA)
must cover anesthesia without cost sharing for preventive colonoscopies if the doctor performing the test deems it necessary. Therefore, you won't pay for necessary anesthesia if you purchased your Cigna Medicare plan through the ACA marketplace. 

Are Colonoscopies Free Under Medicare?

Generally, Original Medicare covers a colonoscopy every 10 years if you have an average risk of developing colorectal cancer. However, you may be eligible for a covered colonoscopy every 2 years if you are at higher risk. All Medicare enrollees are entitled to colonoscopy coverage regardless of their age. 

Does Medicare Cover the Full Cost of a Colonoscopy?

Medicare beneficiaries don't pay anything for a covered colonoscopy if your chosen provider accepts the assignment, and you won't need to pay the Part B deductible. However, you may need to pay 20% of the Medicare-approved amount for any treatment your doctor recommends based on their findings. You may also need to make a copayment for any outpatient services you require following your colonoscopy.

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