Medicare 2026

Polyp Removed During a Medicare Screening Colonoscopy? Your Share Drops to 10% in 2027

Colon cancer screening is one of the clearest wins in Medicare: a screening colonoscopy itself costs you nothing if the provider accepts assignment. But what happens if the doctor finds and removes a polyp during that same screening visit has long caused confusion — and sticker shock — for patients. The good news is that the cost-sharing rules keep getting better, and in 2027 your share goes down again.

Why a "free" screening sometimes came with a bill

Historically, if your doctor removed a polyp during a screening colonoscopy, the procedure was reclassified as diagnostic, and you were charged the standard 20% Part B coinsurance. Congress fixed that, and federal regulations (42 CFR 410.152) are now phasing the patient's share down to zero.

Here is the schedule, in plain English, for a planned screening colonoscopy (or planned screening flexible sigmoidoscopy) in which tissue is removed during the same visit:

• 2022: Medicare paid 80%, you paid 20%.
• 2023 through 2026: Medicare pays 85%, you pay 15%.
• 2027 through 2029: Medicare pays 90%, you pay 10%.
• Beginning January 1, 2030: Medicare pays 100%, you pay nothing.

In Original Medicare, that patient share applies to the provider's services and, in a hospital outpatient department or ambulatory surgical center, to the facility as well. The Part B deductible does not apply to these services.

What the screening covers, and how often

Medicare Part B covers screening colonoscopies, including the anesthesia furnished with them. There is no minimum age for a screening colonoscopy under Medicare.

How often it is covered depends on your risk level:

• Once every 24 months if you are at high risk for colorectal cancer.
• Once every 120 months (or 48 months after a previous screening flexible sigmoidoscopy) for everyone else.

Medicare considers you high risk if a parent, sibling, or child has had colorectal cancer or an adenomatous polyp; if your family has a history of familial adenomatous polyposis or hereditary nonpolyposis colorectal cancer; if you have had adenomatous polyps or colorectal cancer yourself; or if you have inflammatory bowel disease such as Crohn's disease or ulcerative colitis.

And here's a point worth knowing: if you take a Medicare-covered stool-based test or blood-based biomarker screening test and the result is positive, the follow-up colonoscopy is covered as a screening test. You pay nothing for that follow-up colonoscopy when your provider accepts assignment.

How Medigap can help with the remaining share

If you have Original Medicare, a Medicare Supplement (Medigap) policy may pick up all or part of the coinsurance you would otherwise owe when a polyp is removed. On Medicare's standardized comparison chart:

• Plans A, B, C, D, F, G, and M cover the Part B coinsurance in full.
• Plan N covers it except for copays of up to $20 for some office visits and up to $50 for emergency room visits that don't lead to an inpatient admission.
• Plans K and L cover 50% and 75% of it, respectively.

Not everyone can buy Plans C and F; eligibility depends on when you first became eligible for Medicare.

Original Medicare vs. Medicare Advantage: a neutral look

Medicare Advantage plans must cover the same preventive services as Original Medicare, including screening colonoscopies, and they often package medical, drug, and extra benefits together with network rules and plan-set cost sharing. Original Medicare paired with a stand-alone Part D plan — and, if you choose, a Medigap policy — generally lets you see any provider who accepts Medicare and uses the federal cost-sharing rules described above. Each path has trade-offs around networks, referrals, premiums, out-of-pocket exposure, and extra benefits. Compare plans in your area on Medicare.gov and decide what fits your situation.

Other 2027 numbers worth knowing

A few program-level figures are already set for 2027:

• The Part D out-of-pocket cap rises to $2,400 (up from $2,100 in 2026).
• The maximum Part D deductible any plan may charge is $700.
• The Part D base beneficiary premium — used to calculate the late-enrollment penalty — is $41.33. (Actual plan premiums vary.)
• Social Security announced a 3.6% cost-of-living adjustment for benefits payable beginning January 2027.
• Annual Enrollment runs October 15 – December 7, 2026, with changes effective January 1, 2027.

The 2027 Part B standard premium and deductible, and the 2027 IRMAA income brackets and surcharges, had not been announced at the time of writing. CMS typically releases these in the fall. Check Medicare.gov for the official numbers once they post.

A note for people with Medicaid or Extra Help

Since 2025, if you have Medicaid or qualify for Extra Help with Part D, you have a monthly Special Enrollment Period to move to Original Medicare with a stand-alone Part D plan, or to switch stand-alone Part D plans. If you are a full-benefit dual-eligible, you can also enroll in an integrated Dual Eligible Special Needs Plan (D-SNP) in any month.

Where can you get help with Medicare questions?

For official information, plan comparisons in your area, and the latest program figures, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048, 24 hours a day, seven days a week.