Will Insurance Cover Your Colonoscopy Before 45? What to Know as Colon Cancer Cases Rise in Younger Adults

Colonoscopy questions have surged as colorectal cancer diagnoses climb sharply among younger adults, a trend thrust back into the spotlight by the recent death of actor James Van Der Beek at 48. Here’s what to know about insurance coverage, current screening guidelines and who should consider a colonoscopy before age 45.

Most insurance plans will not cover a colonoscopy before age 45 unless you have symptoms, a family history or other risk factors that make the procedure medically necessary.

Under the Affordable Care Act, colorectal cancer screening is a free preventive service starting at age 45, the threshold set by the U.S. Preventive Services Task Force in 2021. People under 45 at average risk who want a colonoscopy can typically get one with a doctor’s referral, but will likely pay out of pocket. If symptoms are present, the colonoscopy is classified as diagnostic rather than screening and is covered differently by insurance. The U.S. Department of Health and Human Services has said the removal of a polyp is an integral part of a screening colonoscopy, meaning patients with private insurance should not pay out of pocket for it. That guidance does not apply to Medicare.

People with a family history of colorectal cancer, a personal history of polyps or inflammatory bowel diseases like Crohn’s and ulcerative colitis face higher risk and may need earlier screening.

About 10% of colorectal cancer cases occur in people younger than 50, according to Mayo Clinic, and 1 in 5 diagnoses now occurs in someone under 55, per the Cancer Research Institute. “People need to talk to their families. Even if your mom had a non-cancerous polyp at age 40, you need to start screening for colorectal cancer younger [than 45],” Rebecca Siegel, senior scientific director of surveillance research at the American Cancer Society, told NBC News. Anyone with symptoms such as rectal bleeding, abdominal pain, unexplained weight loss or changes in bowel habits should talk to a doctor regardless of age.

The U.S. Preventive Services Task Force recommends routine colorectal cancer screening starting at age 45, lowered from 50 in 2021 to reflect the growing incidence in younger adults.

Colorectal cancer is now the leading cause of cancer death in people under 50, even as overall cancer death rates in that age group have dropped 44% since 1990. Risk between ages 40 and 44 is about 21 per 100,000 people but more than doubles to 47 per 100,000 between ages 45 and 49, according to the American Cancer Society. With routine screening, one in three colorectal cancer deaths can be avoided, per the CDC. “The fact that trends do not suggest colorectal cancer rates in young people are dropping certainly does open the door for conversations around policy change dropping the screening age again,” Karlyle Morris, section chief for colorectal cancer at MD Anderson Center in Houston, told NBC News.

A colonoscopy costs between $1,250 and $4,000 or more out of pocket without insurance, according to GoodRx.

For those without coverage, noninvasive stool tests like Cologuard offer a lower-cost alternative, though they are not as comprehensive as a colonoscopy. Other screening options include imaging scans and combinations of endoscopic visualization with stool-based testing. Before scheduling, patients should confirm their doctor is in-network to avoid higher out-of-pocket costs, and ask their insurer how much they will pay and whether that figure could change based on what is found during the procedure. If large bills arrive afterward, patients may be able to appeal the insurance company’s decision.

Yes. Both Blue Cross Blue Shield of Massachusetts and UnitedHealthcare have proposed policies that would have limited colonoscopy coverage or added barriers, though both proposals were reversed after physician and patient pushback.

In 2024, Blue Cross Blue Shield of Massachusetts proposed deeming anesthesia in colonoscopies medically unnecessary, which would have forced patients to pay out of pocket for sedation. The policy was reversed after outcry. In 2023, UnitedHealthcare announced plans requiring its 27 million commercial plan members to obtain insurance approval before diagnostic or follow-up colonoscopies. That plan was put on hold following protests from physicians and patients.

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