Does Kaiser Medicare Cover a Colonoscopy?

In this article...
  • For individuals over age 45, doctors may recommend a colonoscopy to screen for colorectal cancer. Learn when and how Kaiser Medicare covers a colonoscopy.

If you're 45 or older, your doctor may recommend a colonoscopy to screen for colorectal cancer. This common procedure can help your healthcare provider detect polyps, abnormal tissue and other early warning signs of the disease. Although a colonoscopy can cost several thousand dollars or more without insurance, depending on your region, the facility and the reason for testing, Kaiser Permanente’s Medicare Advantage plans cover up to 100% of the cost. If your doctor has recommended this procedure as part of a screening, diagnostic or treatment regimen, here’s what you’ll need to know to make sure Kaiser Medicare covers your colonoscopy.

When Does Kaiser Medicare Cover a Colonoscopy?

Kaiser’s Medicare Advantage plans cover some or all the costs of medically necessary colonoscopies, which may include procedures done to:

  • Screen for colorectal cancer or other conditions involving the large intestine
  • Diagnose individuals with unexplained weight loss, changes in bowel habits and other intestinal-related symptoms
  • Follow-up on abnormal or inconclusive results of a prior colonoscopy or other diagnostic test
  • Remove polyps or foreign bodies from the intestine
  • Place a stent

How Often Does Kaiser Medicare Pay for a Colonoscopy?

Kaiser Medicare Advantage plans pay for a colonoscopy to screen for colorectal cancer at the following intervals:

  • Every 120 months if you have an average risk of developing the disease
  • Every 24 months if you have a high risk of developing colorectal cancer
  • 48 months after undergoing a flexible sigmoidoscopy

Coverage for colonoscopies performed for diagnosis- or treatment-related reasons isn’t governed by frequency. These procedures must be deemed medically necessary by a physician before Kaiser Medicare covers the cost of services.

Does Kaiser Medicare Require a Copay for a Colonoscopy?

If you’re undergoing a screening colonoscopy at a plan-approved interval, Kaiser Medicare doesn’t charge a copay. However, depending on your policy, if you undergo a colonoscopy for diagnosis or treatment purposes, you may be responsible for a copayment or coinsurance for the service and the facility. Because Medicare Advantage must provide at least as much coverage as Original Medicare, the charge should be no more than 20% of the overall cost of service. Some plans may also require participants to meet an annual deductible prior to covering the cost of services.

Because coverage through Medicare Advantage plans may vary widely by region and type, Kaiser Permanente policyholders should contact their plan administrator directly for details on their specific benefits. 

Does Kaiser Medicare Cover Anesthesia, Sedation and Other Related Charges for a Colonoscopy?

Before beginning a colonoscopy, your healthcare practitioner may administer anesthesia, sedation or pain medications. The charge for these items is typically covered by Kaiser Medicare, falling under the same coverage guidelines as the procedure. If anesthesia, sedation or pain medication is required during a screening colonoscopy, Kaiser covers 100% of the cost. If medications or anesthesia are administered during a colonoscopy performed for diagnostic or treatment purposes, a copayment or co-insurance may apply. For diagnostic- or treatment-related colonoscopies, beneficiaries may also have to meet their annual plan deductible, if applicable, before these services are covered.

Does Kaiser Medicare Cover Bowel Preparation Materials?

Prior to a colonoscopy, your doctor will prescribe a bowel preparation kit, which includes prescription laxatives to clear the intestine for clearer imaging. Because Kaiser Medicare plans typically include prescription drug benefits, your policy should pay for some or all the cost of these materials, regardless of why the colonoscopy is being ordered.

Does Kaiser Medicare Have Age Limitations for Colonoscopy Coverage?

Colonoscopy screenings are typically not recommended for individuals over the age of 85. However, Kaiser Medicare covers screening colonoscopies for plan participants of all ages.

What Can You Expect During a Colonoscopy?

You’ll typically begin preparation for a colonoscopy the day before the procedure by taking prescription laxatives to empty your bowels. This lets your physician get a clearer look at the walls of your intestine for a more accurate examination.

When you arrive at the facility on the day of the procedure, your doctor will have you lie on your left side on a table. At that time, they may administer anesthesia, pain medication or a sedative. Then, to begin the test, they’ll insert a narrow scope, known as a colonoscope, through your anus, into your rectum and up through the colon. Using this scope, your healthcare provider can release air or water to inflate the intestine before imaging begins.

A camera on the scope takes video, transmitting it to a monitor so your physician can perform a visual inspection of your intestines in real time. At certain points during the procedure, your doctors may ask you to adjust your position to give them a better view. They may also use the scope to remove polyps or other samples, which are typically sent away for a biopsy.

Most colonoscopies take about 30 to 60 minutes, and the procedure isn't typically painful. Although a colonoscopy has minimal risk of complications, you may experience mild discomfort during the procedure, such as stomach cramping or the need to have a bowel movement. Afterwards, you may also have bloating or gas, but these symptoms should pass within a few hours.

Can I Get Screened for Colorectal Cancer Another Way?

Early signs of colorectal cancer can also be detected using the following screening tools:

  • Virtual colonoscopy: A virtual colonoscopy, which is sometimes referred to as a CT colonography, takes high-resolution images of the large intestine using a CT scanner.
  • Stool DNA tests: This self-administered screening tool detects trace amounts of blood or abnormal DNA in a stool sample.
  • Fecal immunochemical tests: FIT is an at-home screening tool that uses antibodies to detect trace amounts of blood in a stool sample.

Some screenings may need to be repeated as often as every year, and it’s possible to receive a false positive or negative. If testing returns inconclusive or abnormal results, your physician may recommend a colonoscopy for further examination or tissue removal. 

Does Kaiser Medicare Advantage Cover Alternative Colorectal Cancer Screening Tools?

Kaiser Medicare plans may cover alternative colorectal cancer screening methods, such as stool analysis and virtual colonoscopies. Depending on the plan, coverage guidelines may include age or medical criteria, and at-home testing kits, such as Cologuard, typically need to be ordered by a doctor. Because Medicare Advantage plan coverage varies by region and policy, questions about benefits should be directed to a Kaiser Permanente representative.

Weighing Your Colorectal Cancer Screening Options

Screening for colorectal cancer is an important part of healthy aging, and early detection saves lives. Because individuals today have numerous choices when it comes to screening for the disease, it may be helpful to consider the following factors when making a decision:

  • Your risk profile, including personal health considerations and family history
  • Your doctor’s recommendation
  • The potential accuracy of various test options
  • The frequency a test needs to be repeated
  • Your comfort level and personal preferences
  • The potential need for follow-up testing
  • Cost and insurance coverage
  • Convenience

Choosing between a colonoscopy and other testing methods should always involve a conversation with a trusted healthcare professional.

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