Medicare pays for a Cologuard test once every three years. This applies to both the original Cologuard and the newer CologuardPlus test, and there is no copay, coinsurance, or deductible for the screening. However, you need to meet specific age and risk criteria to qualify for coverage.
Who Qualifies for Coverage
Medicare Part B covers Cologuard for beneficiaries between the ages of 45 and 85 who are at average risk for colorectal cancer and have no current symptoms of colorectal disease. The minimum age was 50 when coverage first began in 2014, but CMS lowered it to 45 starting in January 2023.
“Average risk” and “no symptoms” are the two requirements that trip people up most often. To qualify, you must have none of the following:
- Symptoms of colorectal disease: lower gastrointestinal pain, blood in your stool, or a previous positive result on a different stool-based screening test
- Personal history: adenomatous polyps, colorectal cancer, or inflammatory bowel disease (including Crohn’s disease and ulcerative colitis)
- Family history: colorectal cancer, adenomatous polyps, familial adenomatous polyposis, or hereditary nonpolyposis colorectal cancer (Lynch syndrome)
If any of those apply to you, Medicare considers you higher risk. That doesn’t mean you can’t get screened. It means your doctor will likely recommend a colonoscopy instead, which Medicare covers on a different schedule.
What You Pay Out of Pocket
When you meet the eligibility criteria and stay within the once-every-three-years limit, the Cologuard test is classified as a preventive screening service. Medicare Part B covers it at 100%. You owe nothing: no deductible, no coinsurance, no copay.
If you repeat the test before three years have passed, Medicare will not cover the second test, and you could be responsible for the full cost.
What Happens if Your Result Is Positive
A positive Cologuard result means the test detected DNA markers or blood that could indicate precancerous polyps or cancer. The next step is a follow-up colonoscopy to get a direct look. Under current CMS policy, this follow-up colonoscopy is treated as part of the same screening process, not as a separate diagnostic procedure.
That distinction matters for your wallet. Because the colonoscopy is classified as a continuation of the original screening, Medicare covers it with no cost sharing. You won’t owe a copay or coinsurance for the procedure. The normal frequency limits on screening colonoscopies (once every 10 years for average-risk patients) also don’t apply in this situation, so you won’t have a timing conflict if you recently had a colonoscopy for other reasons.
How the Three-Year Clock Works
The three-year window is counted from the date of service on your last covered Cologuard test, not from when you received results or when the calendar year started. If you completed your test on March 15, 2024, your next covered test would be on or after March 15, 2027. Ordering it even a few days early could result in a denial.
Your doctor’s office or the Cologuard manufacturer (Exact Sciences) can typically check your eligibility window before ordering the kit. It’s worth confirming the timing before you collect your sample.
CologuardPlus Coverage
As of October 2024, Medicare also covers the newer CologuardPlus test. The coverage rules are identical: once every three years, ages 45 to 85, average risk, no symptoms. CologuardPlus uses a different testing panel but is billed separately from the original Cologuard. Your provider will determine which version to order.
Medicare Advantage Plans
Medicare Advantage (Part C) plans are required to cover at least everything Original Medicare covers. That means the once-every-three-years Cologuard benefit and the same eligibility criteria carry over. Some Medicare Advantage plans offer additional screening benefits or broader coverage, so it’s worth checking your specific plan documents. But the baseline coverage, including zero cost sharing for the test itself, is guaranteed.
When Cologuard Isn’t the Right Fit
Cologuard is designed for people at average risk who have no symptoms. If you have a personal or family history of polyps, colorectal cancer, or inflammatory bowel disease, Medicare won’t cover Cologuard because it isn’t the recommended screening tool for your situation. A colonoscopy is more appropriate for higher-risk individuals and is covered by Medicare on a different schedule: once every 24 months for high-risk beneficiaries, compared to once every 10 years for average-risk screening colonoscopies.
Similarly, if you’re experiencing symptoms like blood in your stool or persistent abdominal pain, the appropriate path is a diagnostic workup rather than a screening test. Diagnostic colonoscopies are covered by Medicare Part B, though they may involve standard cost sharing (the 20% coinsurance that applies to most Part B services) unless they originated as a follow-up to a positive stool-based screening.