Getting a Cologuard test requires a prescription, but you don’t necessarily need an in-person doctor’s visit to get one. You can request the kit through your regular healthcare provider or through a telehealth service, and it ships directly to your home. The whole process, from prescription to mailed-back sample, can happen without setting foot in a clinic.
Who Qualifies for Cologuard
Cologuard is designed for adults 45 and older who are at average risk for colorectal cancer. That age floor dropped from 50 to 45 in 2023, aligning with updated screening guidelines. If you fall in that age range and don’t have specific risk factors, you’re likely a candidate.
You would not qualify if you have any of the following:
- A personal history of colorectal cancer or advanced precancerous lesions
- A first-degree relative (parent, sibling, or child) diagnosed with colorectal cancer at any age
- Inflammatory bowel disease, including Crohn’s disease or ulcerative colitis
- A hereditary cancer syndrome such as Lynch syndrome or familial adenomatous polyposis
- A positive result from another colorectal screening test within the last 6 months
If any of those apply, colonoscopy is the recommended screening method instead. Cologuard is not a substitute for diagnostic colonoscopy in higher-risk individuals.
Two Ways to Get a Prescription
The most straightforward path is asking your primary care doctor at a regular visit or through your provider’s patient portal. Mention that you’re interested in at-home colorectal screening, and they can write the prescription if you’re eligible. From there, the Cologuard kit ships to your address.
If you’d rather skip the office visit, telehealth is an option. The Cologuard website itself offers an online request path that connects you with an independent telehealth provider. Third-party telehealth services also prescribe Cologuard. A typical telehealth visit involves a short video consultation where a clinician reviews your medical history, confirms you meet the eligibility criteria, and writes the prescription. The kit then ships overnight to your door. Some telehealth providers charge a separate fee for the consultation, so ask upfront.
What Comes in the Kit
The Cologuard box contains everything you need: a sample collection container, a bracket that sits on your toilet, a small probe tube for scraping the stool surface, a bottle of preservative liquid, labels, and a prepaid UPS shipping box. There’s a step-by-step guide included, and the process is designed to be done at home in one sitting.
How to Collect and Return the Sample
Start by checking the expiration date on the kit. Then set up the bracket on your toilet and place the collection container on it. Have a bowel movement directly into the container, keeping urine and toilet paper out as much as possible.
Next, use the provided probe to scrape the surface of the stool sample until the tip is coated, then seal the probe back into its tube. Pour the entire bottle of preservative liquid into the container with the stool and close the lid tightly. Fill out the provided labels with your name, date of birth, and the date and time of collection. Attach one label to the probe tube and one to the container lid.
Pack everything into the shipping box, seal it, and drop it off at any UPS location or schedule a UPS pickup. This is the most time-sensitive part: the lab must receive your sample within 72 hours of collection. Plan your collection for a day when you can get the box to UPS promptly, and avoid collecting on a Friday evening unless Saturday UPS drop-off is available near you.
How Much Cologuard Costs
For most people with insurance, Cologuard is covered as a preventive screening with no out-of-pocket cost. Medicare Part B covers the test once every three years for average-risk individuals, with no deductible and no co-pay when your provider accepts Medicare assignment. Most private insurers follow similar coverage guidelines for ages 45 and up.
Without insurance, Cologuard costs $600 or more. Exact Sciences, the company behind Cologuard, has a patient assistance program worth looking into if you’re uninsured or underinsured.
What Your Results Mean
Results typically go to your prescribing provider, and you may also access them through a patient portal. There are two possible outcomes: negative or positive.
A negative result means no concerning DNA markers or blood were detected in your sample. You’d repeat the test in three years. Keep in mind that Cologuard detects about 92% of colorectal cancers and about 42% of advanced precancerous lesions, so it’s highly effective for cancer but catches fewer precancerous growths. A negative result is reassuring but not a guarantee.
A positive result does not mean you have cancer. It means the test found abnormal DNA markers or hidden blood that need further evaluation. The standard next step is a follow-up colonoscopy, ideally within three months. Research published in JAMA found that completing a colonoscopy within that window provides an important margin of safety for catching any issues at an early, treatable stage.
If you’re on Medicare and your Cologuard comes back positive, the follow-up colonoscopy is covered at no cost to you as long as your provider accepts assignment. However, if a polyp is found and removed during that colonoscopy, you may owe 15% of the Medicare-approved amount for the removal portion of the procedure.
How Accurate Cologuard Is
In its pivotal clinical trial, Cologuard detected 92.3% of colorectal cancers, making it a strong screening tool for catching actual cancer. Its detection rate for advanced precancerous lesions (large polyps that could eventually become cancer) is lower at 42.4%. The test correctly identifies people without disease about 87% of the time, meaning some people will get a positive result that turns out to be nothing concerning after a follow-up colonoscopy.
This is why Cologuard works best as a repeated screening tool over time. What it misses on one round, it may catch three years later on the next. For people who are unable or unwilling to do a colonoscopy, it provides a meaningful layer of protection that’s far better than no screening at all.