Cologuard and Medicare: Exploring Coverage, Cost and Benefits

Introduction

Cologuard is a non-invasive, at-home test used to screen for colorectal cancer. Developed by Exact Sciences, it is the first FDA-approved multi-target stool DNA (mtDNA) test. The test looks for altered DNA and blood in the stool sample, which can be indicative of colorectal cancer.

Medicare is a federal health insurance program administered by the Centers for Medicare & Medicaid Services (CMS). It provides coverage for people 65 years and older, as well as some younger individuals with disabilities. It also covers preventive services like screenings for cancer, including colorectal cancer.

Exploring if Cologuard is Covered by Medicare

Since Cologuard is an approved screening test for colorectal cancer, the question arises whether it is covered by Medicare. To understand this, it’s important to know what is covered by Medicare.

According to the CMS, Medicare Part B covers certain preventive services, including colorectal screenings. This includes flexible sigmoidoscopy, colonoscopy and fecal occult blood tests (FOBT). However, it does not currently cover Cologuard.

The American Cancer Society has stated that “Cologuard is not yet covered by Medicare, but the manufacturer is working with Medicare to make it available to Medicare beneficiaries.” As of now, Cologuard is not covered by any insurance, including Medicare.

Evaluating the Cost of Cologuard for Medicare Patients

For those who are interested in taking the Cologuard test, understanding the cost is essential. According to Exact Sciences, the cost of Cologuard is $649. Since Medicare does not cover the cost of the test, patients would need to pay out-of-pocket.

It’s important to note that there may be additional costs associated with taking the Cologuard test. For example, if your doctor orders the test, you may have to pay for their fees as well. Additionally, if you have to go to a lab to provide a stool sample, there may be lab fees associated with that.

Comparing Cologuard to Other Screening Options for Medicare Patients

When considering a colorectal cancer screening test, it’s important to compare the pros and cons of each option. For Medicare patients, the main screening options are Cologuard and traditional colorectal cancer screenings, such as colonoscopies and FOBTs.

One of the biggest advantages of Cologuard is its convenience. The test can be done at home and does not require any preparation or sedation. Additionally, it only needs to be done once every three years. On the other hand, traditional colorectal cancer screenings require more preparation and are typically done every 10 years.

In terms of cost, Cologuard is generally more expensive than traditional colorectal cancer screenings. According to Exact Sciences, the cost of Cologuard is $649. In comparison, the cost of a colonoscopy can range from $1,500 to $3,000, depending on the provider.

In terms of accuracy, both Cologuard and traditional colorectal cancer screenings have been found to be effective. A study published in the journal Gastroenterology found that Cologuard was 92% accurate in detecting colorectal cancer. Similarly, a study published in the New England Journal of Medicine found that colonoscopy was 93% accurate.

Analyzing the Benefits of Cologuard for Medicare Patients

Despite the fact that Medicare does not currently cover Cologuard, there are still many benefits for Medicare patients. One of the biggest benefits is the accuracy of the test results. As mentioned above, Cologuard has been found to be 92% accurate in detecting colorectal cancer.

Another benefit is the convenience of the test. Cologuard can be done at home and does not require any preparation or sedation. This makes it a great option for those who may not be able to tolerate a traditional colorectal cancer screening.

Examining the Availability of Cologuard for Medicare Patients

For Medicare patients who are interested in taking the Cologuard test, availability can be a concern. Currently, Cologuard is not available through Medicare. However, Exact Sciences is working with Medicare to make it available.

For those who want to access Cologuard, the best way is to contact a provider who accepts Medicare. Exact Sciences has a list of providers who accept Medicare on their website. Additionally, Medicare also has a tool to help you find providers who accept Medicare.

Conclusion

Cologuard is a convenient and accurate screening test for colorectal cancer. Although it is not currently covered by Medicare, it is worth considering for Medicare patients who are looking for a reliable colorectal cancer screening. To access the test, it is important to find a provider who accepts Medicare.

For more information about Cologuard and Medicare coverage, visit the websites of the American Cancer Society and Exact Sciences. Additionally, Medicare.gov has resources to help you find providers who accept Medicare.