COLOGUARD® INSURANCE COVERAGE
We’ve Got Your Back
Cologuard is covered by Medicare and most major insurers. Use our links below to discover if it is covered by your insurance provider today.
If you run into trouble getting coverage, we’ll contact your insurance provider ourselves to see if we can help move things along. Call our Customer Care Center at 1-844-870-8870 to get started.
Most insured patients pay $01
Nationwide, more than 96% of Cologuard patients have no out-of-pocket cost for screening1
Many national and regional insurers have begun paying for colon cancer screening at age 45. Exact Sciences continues to work with payers to expand coverage and access for patients 45-49.
Coverage for Colonoscopy After a Positive Cologuard Result
If you receive a positive Cologuard result, talk to your healthcare or telehealth provider about scheduling a colonoscopy. This will help you understand what a positive result means for you.
Starting 2023, Medicare and most commercial plans cover a colonoscopy following a positive Cologuard result. Exceptions for coverage may apply; please confirm with your insurer. They are the best source of info on your plan and coverage.
If you receive a bill for a colonoscopy, please call our Customer Care Center 24/7 at 1-844-870-8870. Or visit our appeals page to create a customized letter to send to your insurance company.
What happened?
On January 10, 2022, the federal government issued new guidance related to coverage of preventive services under the Affordable Care Act.
What does this mean for patients?
- For plan or policy years beginning on or after May 31, 2022, health plans must cover, without cost sharing, a colonoscopy conducted after a positive stool-based test, including Cologuard.1
- Many health plans already waived the cost after a positive stool-based test. Several states also passed laws that require many plans in those states to cover colonoscopies after a positive stool-based test at no out-of-pocket cost to the patient.
- The federal update makes these protections even more available.
What happened?
The Centers for Medicare & Medicaid Services (CMS) finalized a new policy, effective January 1, 2023.
What does this mean for patients?
- The new policy removes Medicare cost-sharing requirements under Part B for colonoscopy after a patient has a positive stool-based test prior to the procedure.
- Some components of a colonoscopy (such as the removal of tissue) can result in the patient having coinsurance. This cost would apply regardless of whether the patient had a positive stool-based test.
- CMS lowered this cost sharing to 15%. CMS will gradually reduce this coinsurance until it’s completely removed by January 1, 2030.
Find an Insurer
Medicare
Cologuard is covered by Medicare and Medicare Advantage with no co-pay or deductible for eligible patients ages 45-85.
Medicaid
Eligible patients who are actively enrolled in any State Medicaid program can access Cologuard. No payment will be expected from the patient unless the plan requires a co-pay.*
*Cologuard is a preventive service for NY Medicaid and members have no financial responsibility.
Participating Insurance Plans
Cologuard is covered by most major insurers. Type the name of your insurance provider into the search bar to see if your provider is in-network.
Provider Not Found
Don’t see your insurance provider?
If you don’t see your insurance provider, we’re here to help. Call our Customer Care Center at 1-844-870-8870 or send us a chat and we’ll happily check into things for you.
What does “In-network” mean?
“In-network” means that Exact Sciences Laboratories has contracted with the insurer to be part of their preferred lab network, and the insurer will cover the cost of the test if you meet certain clinical criteria.
Some insurers have coverage and network limitations and exclusions. We recommend you call your insurer directly to confirm what they will pay, what they expect you will pay, and if any paperwork is required before you use the test.
Exact Sciences Laboratories does not verify insurance coverage or eligibility.
Even if your insurer is not in-network for Cologuard, it should be covered for eligible patients ages 45-75 with no co-pay or deductible, based on the Affordable Care Act.
*Please note that some insurers may be considered in-network with Exact Sciences Laboratories, but do not allow use of their company name or logo on our website. If you are unsure of your insurer’s status, please contact them directly for more information.
Patient Assistance Program
We believe everyone should have access to the best healthcare options. Our patient assistance program helps patients facing challenges with insurance coverage receive their Cologuard screening at no cost.
If you face these challenges and Cologuard is right for you, you may receive screening at no cost.
Is your household at or below 400 percent of the Federal Poverty Level (FPL)? If so, you might be able to receive Cologuard screening at no cost.2,3
If you apply to receive no-cost Cologuard screening, you'll be asked to provide income documentation. If you qualify for other assistance programs, that may be enough to determine you are eligible for our program.4
Those programs include, but are not limited to:
- Medicaid3
- Supplemental Nutrition Assistance Program (SNAP)
- Supplemental Security Income (SSI)
- Home Energy Assistance Program
Have questions about our assistance program? Interested in applying? Please call our Customer Care Center at 1-844-870-8870 (select "billing option").