COVERAGE
The same easy ordering and broad Cologuard® coverage1
Eligible patients will get the latest test covered by their insurance to ensure uninterrupted access.
Keep ordering Cologuard the same way you always have, and Exact Sciences will determine which test is covered by a patient’s insurance and send them the latest test that is appropriately reimbursed. This way, there are no disruptions in coverage and you can focus on getting your patients screened for colorectal cancer (CRC).
As the Cologuard Plus™ test is available for a longer period, access will expand.
Search insurance providers
Use the tool below to search your patients’ insurance plans and see which version of the Cologuard® test is currently available.
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Have questions about patient access for Cologuard or Cologuard Plus? Contact Customer Care at 1-844-870-8870 for support.
What in-network means
In-network means a health plan has contracted with Exact Sciences Laboratories as part of its preferred lab network. If a patient meets the plan’s clinical criteria, their test may be covered.
Please note that Exact Sciences cannot verify patient's insurance coverage or eligibility.† Coverage and network limitations vary by insurer. To confirm, we recommend the patient contact their insurance provider to understand:
- What they will pay
- What they expect you to pay
- Any required paperwork before using the test
† Some insurers may be considered in-network with Exact Sciences Laboratories, but restrict public use of their name or logo. If you are unsure about a patient's insurer status, please contact the insurer directly.
Most insured patients pay $0 for Cologuard1*
Nationwide, over 96% of all Cologuard patients 45+ have no out-of-pocket costs for screening1*
Insurance coverage
Eligible patients who are actively enrolled in any state Medicaid program can access the Cologuard test. No payment will be expected from the patient unless the plan requires a co-pay.2†
Follow-up colonoscopy coverage
There is no cost sharing for colonoscopy following a positive Cologuard result2,4
January 2022
The federal government issued guidance making it clear that a colonoscopy after a positive noninvasive CRC screening test should be considered part of the screening process.2,4‡
2023 Policy Changes
Positive results from a noninvasive stool-based test, including the Cologuard test, qualify for coverage of follow-up colonoscopy with no cost sharing.2,4‡
As of 2023, Affordable Care Act (ACA) and Centers for Medicare & Medicaid Services (CMS) guidance requires coverage to encourage CRC screening by reducing financial barriers.2,4
Exact Sciences is committed to helping eligible patients access and afford CRC screening
Insurance support:
- Verification of benefits, as requested
- Patient-assisted insurance appeals
Financial support programs:
- Flexible payment plans
- Financial assistance program, based on eligibility
Customer Care:
- Available to providers and patients
- Available at Cologuard.com or by phone at 1-844-870-8870, every day, 6 AM to 10 PM CT
Cologuard ordering
Order the Cologuard test the way that best fits your practice
- Exact Sciences estimate based on historical patient billing as of November 2024. Exceptions for coverage may apply; only your patients’ insurers can confirm how the Cologuard test would be covered.1
- The Cologuard test is a preventive service for NY Medicaid and members have no financial responsibility.2
- For patients with traditional Medicare, a colonoscopy after a positive Cologuard result is still a screening colonoscopy based on updated Centers for Medicare & Medicaid Services regulations, effective January 1, 2023. Medicare does not apply cost sharing to screening colonoscopy. This update does not apply to commercial plans with exempted status.2,4