Cost and coverage
Insurance varies for the Cologuard Plus® test and SimpleScreen™ CRC — check what your plan covers by clicking the tabs below.
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Coverage for
Cologuard Plus
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Coverage for
SimpleScreen CRC
THE COLOGUARD PLUS TEST
Broadly covered, easy to confirm
The Cologuard Plus test is covered for people who are at average risk for colon cancer by Medicare and many major insurers. It only takes a moment to check if your insurance is in-network.
Most insured patients pay $0*
A large number of national and regional insurers already pay for the Cologuard Plus test. We’re committed to working with insurance companies to expand coverage and access for patients aged 45 and above.
Let’s check your insurance
Medicare
The Cologuard Plus test is available with no copay or deductible for eligible Medicare Part B members aged 45 to 85. If you have a Medicare Advantage plan, use the search tool below to see if you’re eligible to receive the Cologuard Plus test.*
Medicaid
The Cologuard Plus test is available to eligible patients enrolled in a growing number of state Medicaid programs. No payment is expected unless the plan requires a copay.* Use the search tool below to see if your Medicaid plan provides access to the Cologuard Plus test.*
Search coverage for the Cologuard Plus test
Use the search tool below to find your insurance provider and see which test is available. A limited number of patients may receive the original Cologuard test from their insurer.
Insurance provider not found
Sorry, but your insurance may be out of network. Please call 1-866-267-2322 (Billing Enterprise) for assistance.
Have questions about your access to the Cologuard Plus test? Don’t see your plan listed? Customer Care is ready to provide answers at 1-844-870-8870.
What in-network means
Simply put, it means that we’ve agreed with your insurer to be part of their lab network. Your health plan will then cover the cost of your test if you meet certain clinical criteria.
Please note that we cannot verify your insurance coverage or eligibility for you.† Some insurers have coverage and network limitations and exclusions. To be sure, please call your insurance provider to confirm:
- What they will pay
- What they expect you to pay
- Any required paperwork before using the test
The good news is, for eligible out-of-network patients aged 45-75, the Cologuard Plus test should be covered without a copay or deductible through the Affordable Care Act.
† Some insurers may be considered in-network with Exact Sciences Laboratories, but do not allow the 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.
Our patient assistance program
We believe everyone should have access to the best health care options. Our patient assistance program can help people who are facing challenges with their insurance coverage.
If your household is at or below 400 percent of the Federal Poverty Level (FPL), you might be able to request a Cologuard Plus test at no cost.†,‡
You’ll be asked to provide income documentation. If you qualify for other assistance programs, that may be enough to decide your eligibility for our program.§
Those programs include, but are not limited to:
- Medicaid§
- Supplemental Nutrition Assistance Program (SNAP)
- Supplemental Security Income (SSI)
- Home Energy Assistance Program
Have questions about our assistance program or would like to apply? Please call our Customer Care Center at 1-844-870-8870 and select “billing option”.
Frequently asked questions
Across the country, the Cologuard Plus test is covered by different insurance plans. Insured patients often have no out-of-pocket cost for screening. Most insured patients pay $0.* Patients whose insurance plans do not yet cover Cologuard Plus may be prescribed the original Cologuard test.
* Exact Sciences estimate based on historical patient billing. Rate of coverage varies by state and region. A limited number of patients may receive the original Cologuard test from their insurer. Exceptions for coverage may apply; only your insurer can confirm how Cologuard would be covered.
Medicaid
The Cologuard Plus test is available to eligible patients enrolled in a growing number of state Medicaid programs. No payment is expected unless your plan requires a copay.* Use our search tool to see if your Medicaid plan provides access.
Medicare
The Cologuard Plus test is available with no copay or deductible for eligible Medicare Part B members aged 45 to 85. If you have a Medicare Advantage plan, use our search tool to see if you’re eligible.
* Exact Sciences estimate based on historical patient billing. Rate of coverage varies by state and region. A limited number of patients may receive the original Cologuard test from their insurer. Exceptions for coverage may apply; only your insurer can confirm how Cologuard would be covered.
The self-pay price for the Cologuard Plus test is $790. This cost is eligible for reimbursement through FSA, HSA, or HRA accounts.
The Cologuard Plus test is covered by Medicare Part B, and coverage through other insurance providers is expanding. To check your plan, use our insurance lookup tool.
SIMPLESCREEN CRC
Covered by Medicare Part B
SimpleScreen CRC is a covered service under Medicare. Medicare Part B (traditional Medicare) patients who meet coverage criteria pay $0, while patients with Medicare Advantage (Part C) plans may have out-of-pocket costs. Confirm coverage with your insurance, and check with your doctor to make sure it's the right screening option for you.