Can You Get Colonoscopy Coverage With United Healthcare Medicare?

In this article...
  • United Healthcare Medicare covers the full cost of preventive screenings, including colonoscopies. Find out if you meet the medical necessity requirements.

Does United Healthcare Medicare cover colonoscopy? The insurance company expanded its colon cancer screening coverage rules in October 2021. Find out whether your plan pays for this recommended test to detect colorectal cancer. 

When Does United Healthcare Medicare Cover Colonoscopy?

Based on the recommendations of the United States Preventive Services Task Force, United Healthcare Medicare covers colon cancer screening with no cost sharing to most adults ages 45 to 75. This includes those in this age group at average risk and with no personal history, family history or symptoms of colorectal cancer.

What Types of Colon Cancer Screening Does United Healthcare Medicare Cover?

United Healthcare Medicare members receive coverage for several types of colorectal cancer screening. Your plan may pay for:

  • Annual fetal occult blood test, designed for early detection of colorectal cancer with screening of stool samples among adults at average risk
  • Cologuard Multitarget Stool DNA Test, available every 3 years for adults in the qualifying age group at average risk
  • Blood-based biomarker testing for adults at average risk of developing colorectal cancer
  • Screening colonoscopy every 2 years for adults with elevated colorectal cancer risk or every 5 years for adults at average risk

You may qualify for colonoscopy coverage every 2 years if you have a personal or family history of polyps or colorectal cancer or if you have a chronic health condition that increases your risk for these diseases.

How Much Does United Healthcare Medicare Cover for a Colonoscopy?

Because a colonoscopy is a preventive procedure, your United Healthcare Medicare plan pays the full cost. The insurance company cannot require copayments or other types of cost-sharing for preventive care under the Affordable Care Act. However, you may be responsible for a copay and receive a bill for 20% of your physician's services if you require polyp or tissue removal during the colonoscopy procedure. Medicare considers these procedures diagnostic rather than preventive.

Do You Need Prior Authorization for a Colonoscopy With Medicare?

United Healthcare Medicare requires prior authorization to confirm medical necessity if you will have your colonoscopy at an outpatient hospital setting, such as an ambulatory surgical center. 

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