A Cologuard test costs roughly $400 to $600 without insurance, though the newer Cologuard Plus version is priced at $790. Most people with insurance pay nothing out of pocket, thanks to federal rules requiring coverage of colorectal cancer screening. Your actual cost depends on your insurance type, age, and risk factors.
Cost Without Insurance
If you’re paying entirely out of pocket, expect to spend $400 to $600 for the standard Cologuard test. The price can vary by provider and region. Cologuard Plus, a newer version of the test, carries a list price of $790. Both versions are eligible for payment through FSA, HSA, or HRA accounts, which means you can use pre-tax dollars even if your insurance doesn’t cover the test directly.
The manufacturer, Exact Sciences, offers a financial assistance program for patients whose household income falls at or below 400% of the federal poverty level. That threshold is roughly $62,400 for a single person or $129,600 for a family of four in 2024. You can reach their assistance team at 866-267-2322 to check eligibility.
Coverage Under Private Insurance
Under the Affordable Care Act, marketplace plans and most employer-sponsored plans must cover colorectal cancer screening with no copay, coinsurance, or deductible for adults ages 45 to 75. Cologuard qualifies as a screening test, so if you’re in that age range and using an in-network provider, your cost should be $0. That said, coverage can vary if your plan is grandfathered (meaning it existed before the ACA took effect and hasn’t been substantially changed) or if the test is ordered outside the normal screening guidelines.
One important detail: if your Cologuard result comes back positive and you need a follow-up colonoscopy, that colonoscopy is also covered at no cost under most private insurance plans. A 2022 federal clarification confirmed that follow-up colonoscopies after a positive stool-based screening test count as part of the preventive screening process, not as a separate diagnostic procedure. Before that clarification, many patients were surprised by bills of $1,000 or more when their colonoscopy was reclassified as diagnostic.
Coverage Under Medicare
Medicare Part B covers Cologuard once every three years with no out-of-pocket cost, but only if you meet all of the following criteria: you’re between 50 and 85 years old, you have no symptoms of colorectal disease (such as blood in your stool or lower abdominal pain), and you’re at average risk for colorectal cancer. Average risk means no personal history of polyps, colorectal cancer, or inflammatory bowel disease, and no family history of colorectal cancer or related genetic conditions.
If you fall outside those criteria, Medicare may not cover the test, and you’d be responsible for the full cost. It’s also worth noting that the no-cost follow-up colonoscopy rule that applies to private insurance does not currently extend to traditional Medicare. If your Cologuard comes back positive and you’re on Medicare, the follow-up colonoscopy may involve cost-sharing. Medicaid expansion plans do follow the private insurance rule, but traditional Medicaid plans generally do not.
How Often You’ll Need to Pay
Cologuard is repeated every three years, which is less frequent than some other screening options. A simple stool blood test (FIT or gFOBT) needs to be done annually. A colonoscopy, by contrast, is recommended every 10 years for average-risk adults. Flexible sigmoidoscopy falls in between at every five years.
The three-year cycle matters for cost planning. If you’re paying out of pocket, you’re looking at $400 to $600 every three years rather than annually. If you’re insured, your plan will typically cover one test per three-year window at no cost. Ordering a repeat test before that window closes could result in a bill, since insurers follow the recommended screening intervals when determining what qualifies as preventive care.
When You Might Face Unexpected Costs
The most common reason people get an unexpected bill for Cologuard is ordering the test outside the recommended screening guidelines. If you’re younger than 45 (or 50 for Medicare), have symptoms that make the test diagnostic rather than preventive, or have a history that puts you in a higher-risk category, your insurer may not classify it as a covered screening. In those cases, you could owe the full retail price.
Another scenario: if your doctor orders the test more frequently than every three years, the additional tests may not be covered. And if you use an out-of-network lab or provider to process the test, your plan’s no-cost guarantee may not apply. Cologuard kits are shipped to your home and mailed back to a single lab run by Exact Sciences, so network issues are uncommon, but it’s worth confirming with your insurer before ordering.