Colorectal Cancer Screening After 60: Medicare Coverage and Options

Turning 60 brings many milestones, but one you might not be celebrating is your increased risk for colorectal cancer. The good news? Medicare covers the screening tests that can catch this cancer early or even prevent it altogether. And better yet, most of these tests won't cost you a dime.

If you're over 60 and haven't had a colorectal cancer screening recently, or if you're not sure which test is right for you, this guide will walk you through everything you need to know about your options and Medicare's coverage.

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Understanding Colorectal Cancer Risk After 60

Age is one of the biggest risk factors for colorectal cancer. According to the National Cancer Institute, the incidence rate jumps dramatically as we get older. For people aged 50 to 64, about 70 cases occur per 100,000 people. But for those 65 and older, that number more than doubles to nearly 157 cases per 100,000 people.

Think of it this way: the colon and rectum have had more time to develop precancerous growths called polyps. These polyps can slowly turn into cancer if left unchecked. That's why screening becomes so important after 60. The tests can find these polyps before they become dangerous.

Your risk increases even more if you have:

• A family history of colorectal cancer or polyps
• Inflammatory bowel disease like Crohn's disease or ulcerative colitis
• A personal history of polyps or colorectal cancer
• Genetic syndromes like Lynch syndrome or familial adenomatous polyposis

People with these risk factors are considered "high-risk" and may need more frequent screening. For everyone else, you're considered "average risk," which still means screening is important—just on a different schedule.

Medicare Coverage for Colorectal Cancer Screening: What You Need to Know

Medicare Part B covers several types of colorectal cancer screening tests, and here's the best part: when you get a preventive screening test, you usually pay nothing. No deductible. No coinsurance. Zero dollars out of pocket, as long as your doctor accepts Medicare assignment.

This is Medicare's way of encouraging you to get screened. The healthcare system knows that finding cancer early—or preventing it altogether by removing polyps—saves lives and reduces costs down the road.

But there's an important catch you need to understand: the difference between a screening test and a diagnostic test.

A screening test is when you have no symptoms and you're just checking to see if anything's wrong. That's what Medicare covers at no cost. But if your doctor finds and removes a polyp during your colonoscopy, that colonoscopy is no longer purely "screening." Medicare still covers it, but now you'll owe 15% of the Medicare-approved amount for your doctor's services. If you're at a hospital outpatient facility or ambulatory surgical center, you'll also pay a 15% facility fee.

This can feel frustrating. You went in for a free screening and ended up with a bill. But finding and removing polyps is exactly what screening is supposed to do. The American Cancer Society notes that this is still far better than the alternative—letting those polyps grow into cancer.

Your Colorectal Cancer Screening Options

Medicare gives you several ways to screen for colorectal cancer. The best test is the one you'll actually complete, so it's worth understanding your options.

Colonoscopy

This is what most people think of when they hear "colorectal cancer screening." A colonoscopy examines your entire colon and rectum using a thin, flexible tube with a camera. If your doctor spots any polyps, they can remove them right then and there.

How often: If you're at average risk, Medicare covers a colonoscopy once every 10 years (120 months). If you're at high risk due to family history or other factors, you can get one every 2 years (24 months).

What it costs: When it's done for screening, you pay $0 if your doctor accepts Medicare assignment. But remember, if polyps are found and removed, you'll owe that 15% coinsurance.

What to expect: The preparation is often the hardest part. You'll need to completely clear out your colon the day before, which involves drinking a special solution and spending a lot of time in the bathroom. The actual procedure is done under sedation, so you won't feel anything or remember it. You'll need someone to drive you home afterward.

Stool-Based Tests

These tests look for blood or abnormal DNA in your stool that might indicate cancer or polyps. You collect samples at home and send them to a lab. They're convenient and non-invasive, but if any test comes back positive, you'll need a follow-up colonoscopy.

Fecal Immunochemical Test (FIT)

This test detects hidden blood in your stool using antibodies. You don't need to change your diet before taking it.

• How often: Once a year (every 12 months)
• What it costs: $0 for the screening test
• Medicare coverage: Available starting at age 50, no upper age limit

Stool DNA Test (Cologuard)

This test looks for both blood and certain DNA markers that cancer cells shed. It can catch some cancers that don't bleed.

• How often: Once every 3 years (36 months)
• What it costs: $0 for the screening test
• Medicare coverage: Available for ages 45 to 85 who are average risk with no symptoms

Guaiac-Based Fecal Occult Blood Test (gFOBT)

An older type of stool blood test that uses a chemical called guaiac. You may need to avoid certain foods before taking it.

• How often: Once a year (every 12 months)
• What it costs: $0 for the screening test
• Medicare coverage: Available starting at age 50

Flexible Sigmoidoscopy

This test is similar to a colonoscopy but only examines the lower part of your colon (the sigmoid colon and rectum). It requires less preparation and usually doesn't need sedation. However, it can miss problems in the upper part of your colon.

How often: Once every 4 years (48 months), but you can't have had a colonoscopy in the past 10 years.

What it costs: $0 for the screening test if your doctor accepts Medicare assignment.

Blood-Based Biomarker Test

This is a newer option that Medicare recently started covering. The test looks for DNA markers in your blood that colorectal cancer cells release. According to Medicare.gov, you're eligible if you're between 45 and 85, have no symptoms of colorectal disease, and are at average risk.

How often: The frequency depends on the specific test.

What it costs: $0 if your doctor accepts Medicare assignment.

Important note: This is a screening test, so like stool-based tests, a positive result means you'll need a follow-up colonoscopy.

What About CT Colonography?

You might have heard about "virtual colonoscopy" or CT colonography, where images of your colon are created using a CT scan. While some Medicare Advantage plans may cover this, traditional Medicare does not currently cover CT colonography for average-risk screening.

A Critical Policy Change You Need to Know About

Here's something important that changed recently: if you have a positive result from a stool-based test or blood-based test, Medicare now covers your follow-up colonoscopy as a screening test—meaning you pay nothing for it.

In the past, that follow-up colonoscopy was considered "diagnostic" because you were investigating an abnormal result. You'd have to pay coinsurance even though you were just following up on a screening test. The Centers for Medicare & Medicaid Services fixed this in 2023. Now both the initial stool or blood test and the follow-up colonoscopy are covered as part of your preventive screening, with no cost to you (as long as no polyps are removed during the colonoscopy).

This is a huge improvement. It means you can choose a convenient at-home test without worrying that a positive result will stick you with a big bill.

Screening Guidelines for People Over 60

The recommendations for colorectal cancer screening change as you get older. Here's what you need to know.

Ages 60-75: Keep Screening

If you're in this age range and in reasonably good health, screening is strongly recommended. The U.S. Preventive Services Task Force says the benefits are clear: finding cancer early improves your chances of successful treatment, and removing polyps can prevent cancer from developing at all.

Your doctor can help you decide which screening test makes the most sense based on your health, preferences, and previous screening history.

Ages 76-85: It Depends

Once you reach 76, the decision to continue screening becomes more personalized. The guidelines say you should talk with your doctor about whether to keep screening based on:

• Your overall health and life expectancy
• Whether you've been screened regularly in the past (if you've never been screened, there's more potential benefit)
• Your personal preferences and values
• Any conditions that would make screening riskier for you

Why does this change at 76? Research from the National Cancer Institute shows that the risks of screening procedures—like bleeding, perforation of the colon, and problems with the bowel prep—tend to increase with age. At the same time, people in this age group often have other health conditions that might limit their life expectancy. If you're unlikely to live another 10 years due to other health issues, finding an early-stage colorectal cancer might not change your overall outcome.

That said, if you're a healthy 78-year-old who's active and has no major health problems, screening might still make a lot of sense. That's why these decisions should be individualized.

Age 85 and Older: Generally Stop

Most medical groups recommend against routine colorectal cancer screening after age 85. The American Cancer Society notes that the risks of screening typically outweigh the benefits at this age due to competing health concerns and shorter life expectancy.

High-Risk Patients: What's Different

If you have certain risk factors, you're considered high-risk for colorectal cancer. This means Medicare covers more frequent screening.

You're considered high-risk if you have:

• A family history of colorectal cancer or adenomatous polyps
• A personal history of adenomatous polyps
• A personal history of colorectal cancer
• Inflammatory bowel disease (Crohn's disease or ulcerative colitis)
• A genetic syndrome like Lynch syndrome or familial adenomatous polyposis

For high-risk patients, Medicare covers:

• Screening colonoscopy every 24 months (2 years) instead of every 10 years
• More frequent follow-up based on your specific risk factors

These more frequent screenings are still covered as preventive care with no cost to you (except the 15% coinsurance if polyps are removed).

Choosing the Right Screening Test

So which test should you choose? The honest answer is: the one you'll actually complete.

The CDC emphasizes that the most important thing is getting screened, period. A perfect test that you never do doesn't help you. A less comprehensive test that you actually complete could save your life.

Here are some factors to consider:

If you want the most thorough option: Colonoscopy examines your entire colon and can remove polyps during the same procedure. You won't need another screening for 10 years if everything looks normal.

If you want to avoid invasive procedures: Stool-based tests or blood-based tests can be done at home with no preparation or sedation. Just remember you'll need a colonoscopy if the test comes back positive.

If preparation is your biggest concern: Flexible sigmoidoscopy requires less prep than a full colonoscopy, though it only checks part of your colon.

If you have trouble with medical appointments: At-home stool tests are convenient, but you'll need to remember to complete and return them every year.

Talk with your doctor about which option fits your health status, risk factors, and lifestyle. The conversation should include your values and preferences, not just medical factors.

What About Medicare Advantage Plans?

If you have a Medicare Advantage plan instead of Original Medicare, you're in luck: your plan must cover the same colorectal cancer screening tests that Original Medicare covers, at the same frequency, with no cost-sharing when you see in-network providers.

However, Medicare Advantage plans can have different rules about which doctors and facilities you can use. Make sure you:

• Use an in-network provider to avoid higher costs
• Get any required referrals before your screening
• Confirm coverage details with your plan before scheduling

Some Medicare Advantage plans may offer additional benefits, like covering CT colonography, which Original Medicare doesn't cover. Check with your plan to see what's available.

Understanding the Costs: What You'll Actually Pay

Let's break down exactly what you can expect to pay for colorectal cancer screening under Medicare.

For Preventive Screening Tests:

When you have a colonoscopy, flexible sigmoidoscopy, stool-based test, or blood-based test purely for screening purposes:

• You pay: $0
• Medicare pays: 100% of the Medicare-approved amount
• No deductible or coinsurance applies

This assumes your provider accepts Medicare assignment, which most do.

When Polyps Are Found and Removed:

If your doctor finds and removes a polyp or takes a biopsy during your colonoscopy:

• You pay: 15% of the Medicare-approved amount for the doctor's services
• You also pay: 15% coinsurance to the facility if it's an outpatient hospital or ambulatory surgical center
• Medicare pays: 85% of the approved amount
• The Part B deductible does not apply

This can vary, but you might end up paying somewhere between $100 and $400 depending on the facility and what was done.

For Follow-Up Colonoscopy After Positive Stool or Blood Test:

• You pay: $0 for the colonoscopy itself (this is now covered as part of screening)
• But you pay: 15% coinsurance if polyps are found and removed during that colonoscopy

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Common Questions and Concerns

"I feel fine. Why do I need screening?"

This is exactly when you should get screened. Screening tests are for people who have no symptoms. By the time colorectal cancer causes noticeable symptoms like blood in your stool, abdominal pain, or weight loss, it's often at a more advanced stage. Screening finds problems early—or prevents them from developing at all.

"The colonoscopy prep sounds awful."

It's not pleasant, but it's usually not as bad as people fear. The prep has improved over the years, and staying near a bathroom for an afternoon is a small price to pay for preventing cancer. If the prep is really keeping you from getting screened, talk to your doctor about alternatives like stool-based tests.

"What if I can't afford the 15% coinsurance if they find polyps?"

First, finding polyps is good news—it means you caught them before they turned into cancer. Second, many hospitals and providers offer financial assistance or payment plans. Don't let fear of costs keep you from getting screened. A Solace Advocate can help you navigate payment options and find assistance programs if needed.

"I'm 78 and healthy. Should I still get screened?"

This is a conversation to have with your doctor. If you're in good health with a life expectancy of 10 years or more, and especially if you haven't been screened regularly in the past, screening could still provide significant benefit. Your doctor can help you weigh the potential benefits against the risks.

How a Solace Advocate Can Help

Colorectal cancer screening should be straightforward, but the healthcare system has a way of making even simple things complicated. That's where a Solace Advocate comes in.

Your advocate can help you:

Understand your specific coverage. Medicare Advantage plans all have different networks and rules. Your advocate can review your plan documents and explain exactly what's covered and which providers you should use to avoid unexpected costs.

Schedule your screening with the right provider. Your advocate can find in-network, Medicare-accepting providers in your area and help you book an appointment. They can often find availability faster than you could on your own.

Prepare for your appointment. Your advocate can help you understand what to expect from the procedure, make sure you have the right preparation supplies, and prepare questions to ask your doctor.

Resolve billing issues. If you receive an unexpected bill after your screening, your advocate can review it, identify any errors, and work with Medicare and your provider to correct the charges. They have a 54% success rate in overturning denied insurance claims.

Coordinate follow-up care. If your screening finds polyps or cancer, your advocate becomes even more valuable. They can help you understand your results, coordinate appointments with specialists, organize your medical records, and ensure all your providers are communicating with each other.

Handle the logistics. If you need a follow-up colonoscopy after a positive stool or blood test, your advocate can make sure it's properly coded as screening (not diagnostic) so you're not charged incorrectly.

You don't have to figure out the healthcare system alone. That's exactly what your advocate is there for—to handle the complicated parts so you can focus on your health.

Frequently Asked Questions

Does Medicare cover colonoscopy if I'm over 60?

Yes. Medicare Part B covers screening colonoscopies for people of all ages. If you're average risk, you can get a colonoscopy every 10 years at no cost. If you're high risk, you can get one every 2 years. The screening itself is free when using a Medicare-accepting provider, but you'll owe 15% coinsurance if polyps are removed during the procedure.

How often should I get screened for colorectal cancer after age 60?

It depends on which test you choose and your risk level. Average-risk individuals can choose a colonoscopy every 10 years, annual stool tests (FIT or gFOBT), a stool DNA test every 3 years, or flexible sigmoidoscopy every 4 years. High-risk individuals should get a colonoscopy every 2 years. Your doctor can help you decide which schedule makes sense for you.

What happens if they find polyps during my screening colonoscopy?

Your doctor will remove them right away, which is exactly what you want. However, this means your procedure is no longer purely "screening," so you'll owe 15% coinsurance on the doctor's services and potentially a 15% facility fee. While this might feel frustrating, removing polyps is the best outcome of screening—it can prevent those polyps from ever becoming cancer. The cost is usually between $100 and $400, far less than treating cancer would cost.

Can I choose a stool test instead of a colonoscopy?

Absolutely. Medicare covers several at-home stool-based tests, including FIT (annual), Cologuard (every 3 years), and gFOBT (annual). These tests are convenient and non-invasive, and they're covered at no cost to you. Just remember that if any stool test comes back positive, you'll need a follow-up colonoscopy to investigate further. That follow-up colonoscopy is also covered as screening with no cost to you (unless polyps are removed).

At what age should I stop getting screened for colorectal cancer?

Most medical organizations recommend routine screening through age 75. For people ages 76 to 85, the decision should be made individually based on your overall health, life expectancy, screening history, and preferences. After age 85, screening is generally not recommended because the risks typically outweigh the benefits. Talk with your doctor about what makes sense for your specific situation.

This article is for informational purposes only and should not be substituted for professional advice. Information is subject to change. Consult your healthcare provider or a qualified professional for guidance on medical issues, financial concerns, or healthcare benefits.

Related Reading

• Understanding Medicare's Preventive Service Coverage
• Medicare Coverage for Preventive Screenings: A Complete Guide
• How to Make the Most of Your Doctor's Appointment
• What Is Patient-Centered Care
• How is Solace covered by Medicare? Here's what you need to know.

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