Privately Insured Patients Not Financially Responsible for Screening Colonoscopy

February 21, 2013

In a major win for the GI community, the government has clarified its policy related to cost sharing for colonoscopy for privately insured patients. Specifically, an FAQ on the implementation of preventive screening benefits in the Patient Protection and Affordable Care Act states that if a screening colonoscopy is performed and a polyp is found and removed during the screening, then an insurer cannot impose cost sharing since it is “an integral part of a colonoscopy.” 

The AGA applauds the administration for this guidance, which provides incentives for Americans to access lifesaving colorectal cancer screenings. We have advocated for this policy revision since the passage of the Affordable Care Act. Read more.

However, patients with Medicare are still subject to colonoscopy cost sharing when a screening turns therapeutic, which affects a large portion of patients who need to be screened. AGA will continue to advocate that legislators correct the colonoscopy cost sharing issue for Medicare patients as well. Read the AGA Issue Brief on Medicare beneficiary cost sharing. We will continue to provide education to patients and providers on this issue.

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