Does Medicare Cover Colonoscopy After Age 70?

Yes. Medicare Part B covers colonoscopy after age 70, and there is no upper age limit. The federal rule governing colorectal cancer screening sets frequency limits based on your risk level but caps no age for colonoscopy, unlike some other screening tests that stop at 85.1eCFR. 42 CFR 410.37 – Colorectal Cancer Screening Tests: Conditions for and Limitations on Coverage Whether you’re 70, 80, or 95, Part B pays for the procedure as long as you meet the scheduling rules. What Medicare will cover and what your doctor recommends can diverge past 75, and that distinction is worth understanding before you schedule.

How Often Medicare Pays

Your eligibility interval depends on how Medicare classifies your risk.

  • Average risk: once every 120 months (10 years). If you had a flexible sigmoidoscopy, you can get a colonoscopy 48 months later instead of waiting the full 10 years.2Medicare.gov. Colonoscopies (Screening)
  • High risk: once every 24 months.2Medicare.gov. Colonoscopies (Screening)

The clock runs from the month of your last screening, not the calendar year. Get screened even a month early and Medicare will not pay.

Who Counts as High Risk

Medicare treats you as high risk if any of the following applies:

Your doctor makes the risk determination. If you have a family history that might qualify, raise it before the procedure is scheduled so it gets coded correctly the first time. Miscoding is one of the fastest paths to a surprise bill.

What You’ll Pay in 2026

A straightforward screening colonoscopy where nothing is found or removed costs you $0 out of pocket when your provider accepts Medicare assignment. The Part B deductible does not apply.2Medicare.gov. Colonoscopies (Screening)

The wrinkle is what happens if your doctor finds and removes a polyp or takes a tissue sample during what began as a screening. Cost-sharing kicks in at that point. In 2026, you pay 15% of the Medicare-approved amount for the doctor’s services. If the procedure is done in a hospital outpatient department or ambulatory surgical center, the facility charges a separate 15% coinsurance. The Part B deductible is still waived even when a polyp comes out.2Medicare.gov. Colonoscopies (Screening)

That coinsurance is on its way out. Congress set it at 10% for 2027 through 2029, and starting in 2030 you’ll owe nothing even if a polyp is removed during a screening colonoscopy.3Centers for Medicare & Medicaid Services. MM12656 – Changes to Beneficiary Coinsurance for Additional Procedures Furnished During Same Clinical Encounter as Colorectal Cancer Screening Tests Until then, 15% can still run to a few hundred dollars depending on the setting.

Bowel Prep Is Separate

The prescription bowel prep is not covered under Part B because it’s a medication, not a procedure. Part D plans may cover some prep kits, but coverage varies by plan and product. Older high-volume preps tend to cost less out of pocket than newer low-volume formulas. Depending on your plan, expect anywhere from under $10 to around $60.

Follow-Up After a Positive Stool Test

If you take a Medicare-covered stool-based or blood-based biomarker test and it comes back positive, the follow-up colonoscopy is treated as a screening for cost-sharing purposes. You pay $0 when your provider accepts assignment. Without this rule the follow-up could be coded diagnostic and you’d owe coinsurance on the whole thing. If a polyp is found and removed during that follow-up, the same 15% coinsurance applies as with any other screening, and the deductible is still waived.2Medicare.gov. Colonoscopies (Screening)

What Doctors Recommend Past 75

Coverage and clinical advice are not the same thing. The U.S. Preventive Services Task Force gives colorectal cancer screening a “C” grade for adults 76 to 85, meaning clinicians should offer it selectively based on overall health, prior screening history, and personal preference. The task force found the net benefit of screening everyone in that age band is small. After 85, the task force says screening should generally stop, because competing health conditions are likely to outweigh any survival benefit.4U.S. Preventive Services Task Force. Recommendation: Colorectal Cancer: Screening

If you’re in good health with a reasonable life expectancy, screening may still make sense past 75, and the case is stronger if you’ve never been screened than if you have a long history of clean results.5National Cancer Institute. Should People Over Age 75 Be Screened for Colorectal Cancer? This is a conversation with your doctor rather than a yes-or-no question. Medicare will pay regardless of what the guidelines say.

Medicare Advantage and Medigap

Medicare Advantage plans must cover everything Original Medicare covers, screening colonoscopies included, and your cost-sharing for a preventive screening should also be $0. The difference is the network. Using an out-of-network gastroenterologist or facility can mean higher costs or no coverage, depending on the plan type. Confirm that both the physician and the facility are in-network before you schedule.

With Original Medicare plus a Medigap policy, the polyp-removal coinsurance is generally picked up. All ten standardized Medigap plan types cover Part B coinsurance, which is where that 15% charge sits. If you have any Medigap plan, in most cases the polyp coinsurance will cost you nothing.

Confirm Assignment and Check the Coding

Before the procedure, call the provider’s office and confirm they accept Medicare assignment. Providers who don’t can charge up to 15% above the Medicare-approved amount, and you pay that difference. If you have Medicare Advantage, confirm network status separately.

After the procedure, review your Medicare Summary Notice and check that the colonoscopy was coded as screening rather than diagnostic. Incorrect coding is the most common reason beneficiaries get billed for a procedure that should have been free. Start with the provider’s billing department. If that doesn’t fix it, your MSN includes instructions for filing an appeal with Medicare.6Medicare.gov. Medicare Appeals