Cologuard is covered by Medicare and most major insurers.
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).
Cologuard is covered by Medicare and Medicare Advantage with no co-pay or deductible for eligible patients ages 50-85.
Many national and regional insurers have begun paying for colon cancer screening at 45. Exact Sciences continues to work with payers to expand coverage and access for patients 45-49.
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.
Cologuard is covered by Medicare and Medicare Advantage with no co-pay or deductible for eligible patients ages 50-85.
| Payor | State |
|---|---|
| Traditional Medicare | National |
| Medicare Advantage | National |
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 a Medicaid provider is listed here.
| State |
|---|
| Arizona |
| California (Medi-Cal) |
| Colorado |
| Connecticut |
| Georgia |
| Idaho |
| Illinois |
| Indiana |
| Kentucky |
| Michigan |
| Minnesota |
| Mississippi |
| Missouri |
| Montana |
| New Mexico |
| New York* |
| North Carolina |
| Ohio |
| Oklahoma |
| Pennsylvania |
| South Dakota |
| Tennessee |
| Vermont |
| Virginia |
| 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 |
|---|---|
| Fallon Community Health Plan | MA |
| Neighborhood Health Plan of Rhode Island | RI |
| Tufts Health Plan | MA, RI |
| UnitedHealthcare Community & State | RI |
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%.
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 “In-network” 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 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.
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 ages 50-75 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.
In Network Plans - Private Insurers
In Network Plans - Medical Groups And IPAs
* TRICARE is a registered trademark of the Department of Defense, Defense Health Agency. All rights reserved
In Network Plans - Private Insurers
In Network Plans - Medical Groups And IPAs
* TRICARE is a registered trademark of the Department of Defense, Defense Health Agency. All rights reserved
Last updated August 2020.
If you have any questions, Customer Care is available 24/7 at 1-844-870-8870
*Exact Sciences estimate based on historical patient billing from October 1, 2019 - January 31, 2020. Rate of coverage varies by state and region. Exceptions for coverage may apply; only your insurer can confirm how Cologuard would be covered for you.
