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.

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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 May 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

Medicaid coverage and enrollment for Cologuard varies by state. At times, Exact Sciences Laboratories may be contracted with an individual Managed Medicaid insurer but not enrolled as a provider with the state’s Medicaid program. If you or your provider has any questions about a specific Medicaid insurer, your state’s enrollment status, or you do not see your state listed, please call our Customer Care Center at 1-844-870-8870. We are available 24 hours a day, 7 days a week.

States where currently enrolled
Arizona
Georgia
Idaho
Kentucky
Minnesota
Missouri
Ohio
Oklahoma
Wisconsin

MEDICAID INSURANCE PLANS-IN NETWORK

Payor State
Partnership Health Plan CA

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
Blue Shield of California CA
Culinary Health Fund NV
Health Plan of Nevada NV
Humana National
Kaiser Foundation Health Plan of Washington ID, WA
Moda Health OR
New Mexico Health Connections NM
Prominence Health Plan NV
Regence BlueCross BlueShield of Oregon OR
Regence BlueCross BlueShield of Utah UT
Regence BlueShield of Idaho ID
Regence BlueShield of Washington WA
United Healthcare National
IN NETWORK PLANS - MEDICAL GROUPS AND IPAs
Payor State
Access Medical Group (HMO) CA
Axminster Medical Group CA
Brown and Toland Physicians (HMO) CA
California IPA 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
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

 

Payor State
Aetna National
Arise Health Plan/WPS Health Insurance WI
Aultcare OH
Avera Health Plans, Inc. SD
BlueCross BlueShield 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
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
Medica Health Plans MN, IA, KS, NE, ND, SD, WI
Medical Mutual of Ohio OH
MercyCare Health Plan WI, IL
MHS Wisconsin WI
Ohio State University Health Plan OH
Physicians Plus WI
Priority Health MI
Prominence Health Plan TX
Quad City Community Healthcare IA
Sanford Health Plan SD
Security Health Plan WI
Swedish Covenant Medical Group IL
Total Healthcare MI
United Healthcare National
Unity Health Plan WI
WEA Trust WI
Wellmark Blue Cross and Blue Shield of Iowa IA
Wellmark Blue Cross and Blue Shield of South Dakota SD

Northeast

 

Payor State
Aetna National
Amerihealth New Jersey NJ
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
ConnectiCare, Inc. MA, RI, NY, CT
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
Humana National
Independent Health Association NY
Tufts Health Plan MA, RI, NH
United Healthcare National
Univera Healthcare NY
UPMC PA

Mid-atlantic

 

Payor State
Aetna National
BlueCross BlueShield of Tennessee TN
CareFirst BlueCross BlueShield DC, MD, VA
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

South

 

Payor State
Aetna National
Blue Cross & Blue Shield of Florida FL
Blue Cross & Blue Shield of Louisiana LA
BlueCross BlueShield of Alabama AL
Florida Health Care Plans, Inc. FL
Humana National
United Healthcare National