What is Colorectal Cancer and How Can Medicare help?

March 8, 2017

Colorectal cancer is a cancer that starts in the colon or rectum.  These are part of the large intestine, which is the lower part of a human being’s digestive system.  A colorectal cancer often begins as a growth called a polyp, which can form on the inner wall of the colon or rectum.  Most of these polyps develop into cancer over time, so removing them can prevent cancer.  This is where Medicare screenings can be helpful.  Preventive screenings can find and diagnose polyps and remove them to save lives!

Colorectal cancer is the second leading cause of cancer death among men and women in the U.S.  The cancer affects people in all racial and ethnic groups and is most common in people aged 50 and older.  Medicare beneficiaries should take advantage of the screenings covered by their Plans and get such conditions diagnosed as early as possible.  All beneficiaries who have Medicare Part B (Medical Insurance) and are 50 years old or older are eligible for coverage for colorectal screenings.

The screenings typically include:

  • Screening barium enema: This test is covered by Medicare once every 48 months for people who are 50 years or older, and once every 24 months for individuals prone to high risk of developing the cancer.  Medicare only covers this test if it is used instead of a flexible sigmoidoscopy or colonoscopy.
  • Screening colonoscopy: Medicare covers this test once every 24 months for individuals at a high risk of colorectal cancer.  Otherwise, Medicare covers this test once every 120 months, or once every 48 months after a previous flexible sigmoidoscopy.
  • Screening fecal occult blood test: Medicare covers this test once every 12 months for people who are 50 years of age or older.
  • Multi-target stool DNA test: This is an at-home test covered every 3 years for people who:
    • Are between 50 and 85 years of age.
    • Show no symptoms of colorectal disease, like gastrointestinal pain, blood in stool, positive guaiac fecal occult blood test or fecal immunochemical test.
    • Have no personal history of adenomatous polyps, colorectal cancer, inflammatory bowel disease including Crohn’s Disease and ulcerative colitis.
    • Have no family history of colorectal cancers or adenomatous polyps, familial adenomatous polyposis, or hereditary nonpolyposis colorectal cancer.
  • Screening flexible sigmoidoscopy: This test is covered once every 48 months for people 50 years of age or older.  For individuals who are not at high risk of the cancer, Medicare covers this test once every 120 months, after a previous screening colonoscopy.

If screenings result in biopsy or removal of a lesion or polyp during the same visit, the procedure is considered diagnostic and only coinsurance and copayment costs need to be paid.  Part B deductible does not apply.  For Barium enemas, beneficiaries pay 20% of the Medicare-approved amount for doctor’s services.  In a hospital outpatient setting for such cases, a copayment is also charged.  DNA tests, fecal occult blood test, colonoscopy, and flexible sigmoidoscopy are usually free.  To find out more on the procedures and costs, talk to your doctor or health care provider.

This is not a complete description of Colorectal Cancer or Medicare Preventive Services.  To learn more about Medicare health insurance plans and benefits available in your area speak with a Medicare specialist or contact Medigap, Inc. at 1-855-214-4404.



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