Insurance and Billing

Cologuard is covered by Medicare and most major insurers

Cologuard is covered by Medicare and Medicare Advantage with no co-pay or deductible for eligible patients.

More than 85%* of all Cologuard patients have no out-of-pocket cost for screening.

Based on the Affordable Care Act, Cologuard should be covered by most private insurers with no co-pay or deductible for eligible patients (ages 50-75; at average risk for colon cancer; without symptoms). Some exceptions may apply, so we recommend patients call their insurer to confirm.

Billing

We highly encourage patients who receive a bill with out-of-pocket responsibilities after using Cologuard to call 1-844-870-8870 and speak with a member of our Patient Support Team to discuss appeal support.

*Rate of coverage varies by state and region. Coverage rate only applies to Cologuard screening population.

Insurance & Billing Flyer

For more information on insurance and billing, download the flyer below.

Download

Find a specific insurer

Expand each of the categories below to look for your specific insurance plan. This is not an exhaustive list as plans are being added regularly.

Last updated October 2018

Medicare & Medicare Advantage

Cologuard is covered by Medicare and Medicare Advantage with no co-pay or deductible for eligible patients.

Payor State
Traditional Medicare National
Medicare Advantage National

Medicaid

For Exact Sciences to be able to submit claims on your behalf to your state or Managed Medicaid plan for payment we also must be enrolled (‘signed up’) as a Medicaid provider in your state. The current list of states where Exact Sciences Laboratories is enrolled as Medicaid provider is listed here.

State
Arizona
Georgia
Idaho
Kentucky
Minnesota
Missouri
Montana
New York*
Ohio
Oklahoma
South Dakota
Wisconsin

*Cologuard is a preventative service for NY Medicaid and members have no financial responsibility.

Sometimes, we can contract directly with Managed Medicaid plans in states where we are not enrolled as a provider. The current list of these Managed Medicaid plans and their locations are listed here.

Payor State
Neighborhood Health Plan of Rhode Island RI
Partnership Health Plan CA

What if I don’t see my state or plan listed here?

Please check back regularly as we continue to add new states and plans. Before you cancel your Cologuard test, stop and call our Customer Care Center at 1-844-870-8870 to request information about Exact Sciences’ financial assistance program. You may qualify for a discount of up to 100%.

Commercial Insurance - In-Network

Select your region on the map to see if your insurance plan has contracted with Exact Sciences to be part of their preferred lab network.*

What does this mean? 

“In-network” means that Cologuard has contracted with the insurer to be part of their preferred lab network, and the insurer will cover the cost of the test if you meet certain clinical criteria.

We recommend you call your insurer if you have any questions about how they will cover Cologuard for you.

Exact Sciences does not verify insurance coverage or eligibility.

*Even if your insurer is not in-network for Cologuard, it should be covered for eligible patients with no co-pay or deductible, based on the Affordable Care Act. 

*Please note that some insurers may be considered in-network with Exact Sciences Laboratories, but do not allow use of their company name or logo on our website.  If you are unsure of your insurer’s status, please contact them directly for more information.

Select your region

Cologuard insurance map

In-Network What does this mean?

“In network” means that Cologuard has contracted with the insurer to be part of their preferred lab network, and the insurer will cover the cost of the test if you meet certain clinical criteria.

Some insurers have coverage and network limitations and exclusions. We highly recommend you call your insurer directly to confirm what they will pay, what they expect you will pay, and if any paperwork is required before you use the test.

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West

IN NETWORK PLANS - PRIVATE INSURERS

Payor State
Aetna National
Anthem Blue Cross of California CA
Blue Cross and Blue Shield of Montana MT
Blue Shield of California CA
Cigna National
Coquille Tribe OR
Culinary Health Fund NV
Health Plan of Nevada NV
Hometown Health NV
Humana National
Kaiser Foundation Health Plan of Washington ID, WA
Moda Health OR
New Mexico Health Connections NM
Prominence Health Plan NV
Public Employees Health Plan (PEHP) UT
Regence BlueCross BlueShield of Oregon OR
Regence BlueCross BlueShield of Utah UT
Regence BlueShield of Idaho ID
Regence BlueShield of Washington WA
Scripps Health Plan Services CA
United Healthcare National
United Medical Resources (UMR) National
IN NETWORK PLANS - MEDICAL GROUPS AND IPAs
Payor State
Access Medical Group (HMO) CA
Affinity Medical Group (CA) CA
Axminster Medical Group CA
Brown and Toland Physicians (HMO) CA
California IPA CA
Central Valley Medical Providers (CA) CA
Community Care IPA CA
Dignity Health Medical Group-Inland Empire CA
Dignity Health Medical Foundation CA
Facey Medical Group (HMO) CA
Humboldt IPA CA
Medi Choice IPA CA
Mercy Medical Group CA
Meritage Medical Network (HMO) CA
Palo Alto Medical Foundation CA
Premier Care IPA CA
SanSum Clinic (HMO) CA
Santa Clara County IPA CA
Sante Medical Group (CA) CA
Scripps Coastal Medical Center (CA) CA
Scripps Coastal Medical Group (CA) CA
Seoul Medical Group (HMO) CA
Sequoia Physicians Network CA
St. John's Health Center CA
Sutter East Bay Medical Foundation CA
Sutter Gould Medical Foundation CA
Sutter Independent Physicians CA
Sutter Medical Foundation CA
Sutter Pacific Medical Foundation CA
Woodland Clinic CA

Midwest

IN NETWORK PLANS - PRIVATE INSURERS 

Payor State
Aetna National
Anthem Blue Cross and Blue Shield – Indiana IN
Anthem Blue Cross and Blue Shield – Missouri MO
Anthem Blue Cross and Blue Shield – Ohio OH
Anthem Blue Cross and Blue Shield – Wisconsin WI
Arise Health Plan/WPS Health Insurance WI
Aultcare OH
Avera Health Plans, Inc. SD
Blue Cross and Blue Shield of Illinois IL
BlueCross BlueShield of Michigan and Blue Care Network of Michigan (JVHL BCN Participating Provider) MI
BlueCross BlueShield of Nebraska NE
Blue Cross & Blue Shield of Minnesota MN
Blue Cross Blue Shield of North Dakota ND
Blue Cross Blue Shield of Texas TX
Cigna National
Common Ground Healthcare Cooperative WI
Dean Health Plan/Prevea360 Health Plan WI
Group Health Cooperative Eau Claire WI
Group Health Cooperative of South Central WI WI
Health Alliance Medical Plans, Inc. IL
Health Alliance Plan of Michigan MI
HealthPartners MN, IA, WI
Health Tradition Health Plan WI
Humana National
Indiana University Health Plans IN
McLaren MI
Medica Health Plans MN, IA, KS, NE, ND, SD, WI
Medical Mutual of Ohio OH
MercyCare Health Plan WI, IL
MHS Wisconsin WI
Network Health WI
Ohio State University Health Plan OH
Physicians Health Plan of Northern Indiana IN
Physicians Health Plan MI
Physicians Plus WI
Priority Health MI
Progress Health IL
Prominence Health Plan TX
Quad City Community Healthcare IA
Sanford Health Plan SD
Sinai Medical Group IL
Total Healthcare MI
United Healthcare National
United Medical Resources (UMR) National
Unity Health Plan WI
Vista360health TX
WEA Trust WI
Wellmark Blue Cross and Blue Shield of Iowa IA
Wellmark Blue Cross and Blue Shield of South Dakota SD
IN NETWORK PLANS - MEDICAL GROUPS AND IPAs
Payor State
Swedish Covenant Physician Partners IL

Northeast

 

Payor State
Aetna National
Agewell NY
Amerihealth New Jersey NJ
Anthem Blue Cross and Blue Shield – Connecticut CT
Anthem Blue Cross and Blue Shield – Maine ME
Anthem Blue Cross and Blue Shield – New Hampshire NH
Blue Cross & Blue Shield of Massachusetts MA
BlueShield of Northeastern New York NY
BlueCross BlueShield of Western New York NY
Blue Cross & Blue Shield of Rhode Island RI
Blue Cross and Blue Shield of Vermont VT
Capital BlueCross PA
Cigna National
ConnectiCare, Inc. MA, RI, NY, CT
Empire BlueCross BlueShield NY
Excellus BlueCross BlueShield NY
Fallon Community Health Plan MA
Geisinger Health Plan PA
Harvard Pilgrim Health Plan MA
Healthsmart World Trade Center Health Plan NY
Highmark Blue Cross and Blue Shield PA, WV, DE
Horizon Blue Cross Blue Shield of New Jersey NJ
Humana National
Independent Health Association NY
Neighborhood Health Plan, Inc. MA
Neighborhood Health Plan of Rhode Island RI
Tufts Health Plan MA, RI, NH
United Healthcare National
United Medical Resources (UMR) National
Univera Healthcare NY
UPMC PA
US Family Health Plan of New York NY

Mid-atlantic

 

Payor State
Aetna National
Anthem Blue Cross and Blue Shield – Kentucky KY

Anthem Blue Cross and Blue Shield in Virginia

(PPO only; HMO Healthkeepers/Healthkeepers Plus must obtain in-network exception)

 VA
BlueCross BlueShield of Tennessee TN
CareFirst BlueCross BlueShield DC, MD, VA
Cigna National
FirstCarolinaCare NC
Highmark Blue Cross and Blue Shield PA, WV, DE
Humana National
Johns Hopkins Employer Health Programs MD
Johns Hopkins US Family Health Plan MD
Optima Health VA
Piedmont Community Health Plan VA
Sentara Health Plan VA
United Healthcare National
United Medical Resources (UMR) National

South

 

Payor State
Aetna National
Blue Cross & Blue Shield of Florida FL
Blue Cross and Blue Shield of Georgia, Inc. (PPO only; HMO/Open Access POS must obtain in-network exception) GA
Blue Cross & Blue Shield of Louisiana LA
BlueCross BlueShield of Alabama AL
Cigna National
Florida Health Care Plans, Inc. FL
Humana National
United Healthcare National
United Medical Resources (UMR) National
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