Does Humana Medicare Cover a Colonoscopy?
- Medicare Advantage plans like those offered by Humana can cover a colonoscopy once every 24 months if you have high risk of colon cancer and once every 10 years if you’re not at high risk. Some plans may offer even more colorectal health benefits.
Humana Medicare Advantage (Medicare Part C) plans provide a wide range of benefits, and among the covered services are colonoscopies.
In fact, all Medicare Advantage plans are required by law to cover everything found in Original Medicare (Part A and Part B). And because colonoscopies are covered by Medicare Part B, that means all of Humana Medicare Advantage plans will cover a colonoscopy the same way it would be covered by Original Medicare. In fact, some Humana Medicare plans may cover more colorectal health benefits than Original Medicare.
When Does Medicare Pay for a Colonoscopy?
If you have a high risk of colon cancer, Medicare Part B will cover a colonoscopy screening once every 24 months.
If you are not at high risk of colon cancer, Medicare will cover a colonoscopy once every 10 years or within four years after a flexible sigmoidoscopy.
Medicare typically defines a high risk for colon cancer as anyone with a personal history or family history of colon cancer or colorectal polyps or an inflammatory bowel disease like Crohn’s disease or ulcerative colitis.
How Much Does Humana pay for a Colonoscopy?
Humana colonoscopies typically cost nothing if the doctor performing your colonoscopy accepts Medicare assignment and is part of your plan network, if you have one. A colonoscopy is considered preventive care, which is covered by Medicare at 100%, with no applied deductible.
However, if a polyp is found and removed during the procedure, you might be responsible for a 20% Medicare Part B coinsurance payment.
The above costs pertain to Medicare Part B. Medicare Advantage plans like the ones offered by Humana must cover colonoscopy costs because they would also be covered by Original Medicare as a preventive procedure. But some Medicare Advantage plans may charge more or less than the standard 20% coinsurance for the removal of a polyp.
Other Colorectal Screenings Covered by Humana Medicare Plans
In addition to a colonoscopy, Medicare Part B (and all Humana Medicare Advantage plans) may cover the following colorectal screening procedures when certain criteria is met.
- Screening fecal occult blood test – Covered annually when a referral is made by a doctor, physician’s assistant, nurse practitioner or clinical nurse specialist
- Multi-target stool DNA test – Covered once every three years for beneficiaries who have an average risk of colon cancer, show no signs or symptoms of colon cancer and are between the ages of 50 and 85
- Screening flexible sigmoidoscopy – Covered every 48 months for those at high risk of colon cancer and every 10 years following a screening colonoscopy for those not at high risk.
- Screening barium enema. Covered every 24 months for those at high risk of colon cancer or every 48 months otherwise. A 20% coinsurance applies under Medicare Part B, and the coinsurance amount may or may not be more with a Humana Medicare plan.
Colonoscopy preparation is not covered by Original Medicare. However, this may be covered by a Humana Medicare Advantage plan with prescription drug coverage or by a Medicare Part D plan.
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