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How to Get a Free (or Low Cost) Colonoscopy

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    The second most fatal cancer in the United states is colorectal cancer – a highly preventable form of cancer when detected in its earliest stages. Consequently, physicians, experts, and government health programs encourage all adults to be screened for colon cancer from the age of 45 to age 75. While there are many screening methods available to patients, the widely preferred method is a colonoscopy. 

    A colonoscopy gives physicians the opportunity to examine the entire colon to detect the presence of polyps and, if found, remove them immediately. While other colorectal screening tests can detect colorectal cancer and the presence of polyps, only a colonoscopy offers the physician a chance to immediately remove precancerous abnormal tissues during the procedure. 

    A free or low-cost colonoscopy is available to you with assistance programs and the Affordable Care Act

    The Affordable Care Act (ACA) compels private insurers and government health insurance carriers like Medicare to fully cover your screening colonoscopy. This means that if you have Medicare or private health insurance, your screening colonoscopy is typically free.

    How to Get a Free (or Low Cost) Colonoscopy

    The Affordable Care Act (ACA) compels private insurers and government health insurance carriers like Medicare to fully cover your screening colonoscopy. This means that if you have Medicare or private health insurance, your screening colonoscopy is typically free. Nonetheless, there are added fees and costs that can make it difficult for financially-challenged people to afford the entire cost of a colonoscopy. Many people do not have insurance and have to completely cover the cost of the procedure that can run between $1000 to $5000 or more depending on where you get the procedure and if you have a polyp removed. 

    Fortunately, there are a number of government and private programs that offer financial assistance to those who can not afford to pay for a colonoscopy. Government programs such as Medicare and Medicaid typically cover the entire cost of a colonoscopy. Other state and private programs will cover part or all of the procedure for you if you qualify. In this article, you will be provided with information to help you access these resources and relieve any anxiety or stress you may have about the financial burden associated with a colonoscopy. 

    Using Medicare and Medicaid

    Both Medicare and Medicaid are government-run medical programs that offer people who qualify health insurance and assistance with paying for medical procedures like colonoscopies. Medicare is a federal health insurance program for people over the age of 65, disabled people, and patients who have end-stage renal disease. You become eligible for Medicare when you pay money into trust funds over time by paying taxes to the social security program. Most people are enrolled in Medicare through the Social Security Administration and do not have to enroll. 

    Medicaid is a financial assistance program run by local and state governments under federal guidelines that serves low-income people of all ages. People with Medicaid usually do not have to pay any medical-related costs but sometimes have to pay a small co-payment. If you have Medicaid, payments for services are paid directly to your healthcare provider. Pregnant women, children, teenagers, and all people who have limited income and resources can apply and are usually eligible for Medicaid. People who have extremely high medical bills that they cannot pay may also qualify for Medicaid. Each state has its own guidelines regarding who is eligible and what services you receive.

    Medicare

    The cost of the colonoscopy is a deterring factor for many people who have limited income and resources and that’s where Medicare comes in. Medicare will cover your colonoscopy every 2 years if you are at an elevated or high risk for colorectal cancer. You are considered at high risk if you have any of the following:

    • Personal history of irritable bowel syndrome, such as Crohn’s disease or ulcerative colitis
    • Family or personal history of familial adenomatous polyposis such as Lynch syndrome
    • Personal history of polyps and/or adenomas
    • Family history of hereditary non-polyposis colon cancer
    • Having a close relative who has had colorectal disease or polyps before the age of 60
    • Having two first degree relatives who have had colon cancer at any age

    Those not at a high risk for colorectal cancer are covered every 10 years. 

    Your colonoscopy is completely covered by Medicare (if your doctor accepts Medicare) unless there is a polyp or abnormal tissue found and removed during the procedure. In these cases, you may have to pay 20% of the total cost owed to your doctor and a copayment to the hospital if done there. Medicare will cover the entire cost of your colonoscopy if it is considered a screening colonoscopy. Your colonoscopy is a screening colonoscopy if you are:

    • Between 50-75 years of age
    • Have no prior history of polyps or colon cancer
    • Have no gastrointestinal (GI) symptoms prior to colonoscopy

    If you are on Medicare and are awaiting a screening colonoscopy, be sure to choose a physician that agrees to the rate that Medicare pays for the procedure. This is referred to as an “accepted assignment”. Once your physician accepts the assignment you typically should not have to pay any costs for the procedure itself. 

    Medicaid

    Medicaid is essentially a medical funding program that is run by the state and the determination of whether your colonoscopy is covered is dependent upon if your state approves. States are able to cover these screenings, but there is no assurance that you can get a free colonoscopy for a cancer screening. In other words, the funding varies from state to state and you will need to contact Medicaid to see if your colonoscopy will be covered. In most cases, the screening is authorized and you will be able to get the procedure at no cost to you.

    Other Government Programs

    There are government programs that were created to get as many people screened as possible, especially those who are less likely to screen for colon cancer. There are several evidence-based programs in the United States that reach out to the underserved populations. These include:

    • Colorectal Cancer Control Program
    • Against Colorectal Cancer in Our Neighborhoods
    • Colorectal Cancer Education, Screening, and Prevention Program
    • Colorectal Cancer Screening in Chinese Americans Project
    • Colorectal Cancer Screening Intervention Program
    • El Proyecto de Salud Colorectal 
    • Kukui Ahi (Light the Way): Patient Navigation
    • Targeting Cancer in Blacks (TCiB)

    The National Institutes of Health has a web page devoted to giving information and access to these programs. If you are interested follow this link here.

    Cheaper Private Market Alternatives

    In some cases, people may not be able to qualify for government assistance to cover the cost of a colonoscopy. If you are one one of those, do not be discouraged! There are ways to reduce the cost of your colonoscopy by using simple strategies. Further, some companies offer programs to fund your colonoscopy and pay the balance over time. 

    Shop Around

    Before you go in for a colonoscopy, shop around to find the most affordable option for you. Hospitals and clinics are required by the Centers for Medicare and Medicaid Services to publish price lists online for common procedures such as a colonoscopy.

    Before you go in for a colonoscopy, shop around to find the most affordable option for you. Hospitals and clinics are required by the Centers for Medicare and Medicaid Services to publish price lists online for common procedures such as a colonoscopy.If this information is difficult to locate, you can also call hospitals, surgery centers, and gastroenterologists to compare the cost of services and related costs. Ask specifically about the following costs:

    • Consultation fee before the procedure
    • Physician’s fee
    • Sedation or anesthesia fees
    • Pathology fees (including the cost of a polyps removal and biopsy)
    • Facility fees

    Financial Aid

    Many hospitals and clinics have financial aid programs that often offer discounts or interest-free payment plans. There is also financial assistance available through organizations such as the Colorectal Cancer Alliance who offer low- or no-cost screenings to those in need. Before you schedule your colonoscopy, ask if the facility offers financial aid or reduced fees and if they have interest-free payment programs. 

    Colonoscopy Assist Programs 

    In some cases, a colonoscopy can cost upwards of $3000, especially if you need a polyp removal. Colonoscopy assist programs can help to reduce the overall cost of your colonoscopy significantly. These programs typically offer an all-inclusive rate for a colonoscopy at participating healthcare facilities throughout the United States. The flat rate for the colonoscopy includes physician, pathology, and facility fees as well as the cost of the sedation and any removal of polyps or taking a biopsy that occur during the procedure.  

    Alternative Colorectal Screening Options

    If you are a low or average risk for developing colorectal cancer, discuss with your doctor the alternative colon cancer screening options available to you. At home colon cancer screening test kits are usually exceptionally cheaper than a colonoscopy and can help rule out the possibility that you have a polyp or colon cancer. These tests are non-invasive and can detect blood in your stool caused by a polyp or colon cancer. These at home stool tests also are inexpensive and offer you a cheaper alternative. Keep in mind that if you receive a positive result from an at home colon cancer screening test you will still have to get a colonoscopy. Unfortunately, these colonoscopies are considered a diagnostic  colonoscopy and are not covered by the ACA and you will usually have to pay for the procedure. 

    References

    Colonoscopy Assist Writing Staff. (2021). Nationwide colonoscopy program. Retrieved from ColonscopyAssist: https://colonoscopyassist.com/program-details/colonoscopy/

    Colorectal Cancer Alliance. (2021). Financial assistance programs. Retrieved from Colorectal Cancer Alliance: https://www.ccalliance.org/patient-family-support/financial-assistance-programs

    Gates, A., Ranji, U., & Snyder, L. (2014, November 13). Coverage of preventative services for adults in Medicaid. Retrieved from KFF:
    https://www.kff.org/report-section/coverage-of-preventive-services-for-adults-in-medicaid-survey-findings/

    Medicare Writing Staff. (2021). Colonoscopies. Retrieved from Medicare.gov: https://www.medicare.gov/coverage/colonoscopies

    Nall, R. (2019, December 12). Is colonoscopy covered by Medicare? Retrieved from Healthline:
    https://www.healthline.com/health/medicare/does-medicare-cover-colonoscopy

    National Cancer Institute. Colorectal cancer screening evidence-based programs listing. Retrieved from NIH:
    https://ebccp.cancercontrol.cancer.gov/topicPrograms.do?topicId=102265&choice=default

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