This month, the Centers for Medicare & Medicaid Services (CMS) issued its final National Coverage Decision for Cologuard, making it the first FDA-approved stool DNA test for the detection of colon cancer and precancer covered for Medicare patients throughout the country. This came after the exciting US FDA approval of Cologuard in August. You may have heard some buzz earlier this week about Cologuard’s availability to the public. It turns out some of these facts were incorrect. In order to eliminate any confusion around this new colon cancer screening test, we’re setting the record straight. Check out our updated FAQ to find out what you need to know.
I have Medicare. Is Cologuard now covered under my insurance?
Yes, on October 9, 2014 the Centers for Medicare & Medicaid issued a final determination and declared that Cologuard would be covered immediately for those on Medicare. Speak with your medical professional to determine if Cologuard is right for you.
I have insurance through another provider. Is Cologuard now covered for everyone?
No, Cologuard is not yet covered by private insurance. Exact Sciences, the maker of Cologuard, is actively working to get Cologuard approved for coverage by private insurance. We currently do not know when this will become effective.
Even though Cologuard is not covered by private insurance, can I still reach out to my insurance provider to see if they would approve the Cologuard test for me?
Yes, you may reach out to your insurance provider to determine if they would approve the request. Exact Sciences offers a program called Cologuard Assurance that will help you with this process. This program will work with your insurance provider to request coverage of Cologuard. If your insurance company approves coverage of the test, you will be required to submit a $50 copay. If your insurance company denies the request, you will be required to pay $599, the full-cost of the Cologuard test.
I recently heard on the news that Cologuard is only offered through the Mayo Clinic. Is this true?
No, Cologuard is available through medical providers across the US. Speak with your medical professional to determine if this test is right for you.
Learn more about Cologuard in our recent Colon Health Alert. You can also visit cologuardtest.com or to call their Customer Support Center at 1-844-870-8870 for more information. And don’t forget, the Colon Cancer Alliance serves as a source of information about colon health. If you have additional questions about colon cancer screening or are in need of support, please contact our free Helpline at (877) 422-2030. We’re here to help!
The Colon Cancer Alliance provides patients and the general public with vital information about colorectal cancer, its prevention and treatment. Reference herein to any specific commercial products, process or service by trade name, trademark, manufacturer or otherwise, does not constitute or imply its endorsement, recommendation or favoring by the Colon Cancer Alliance. The information provided in this post is designed to help empower patients and does not replace the direct relationship between patients and health professionals. Patients should not make healthcare decisions based on information in this post without first contacting your physician or healthcare professional.