Medicare 2026

Colon Cancer Screening Without a Colonoscopy: Medicare's Stool, Blood and CT Options

A colonoscopy is not the only way to screen for colorectal cancer under Medicare. If the idea of the prep, the sedation, or taking a day off has been keeping you from getting screened, it helps to know that Medicare Part B covers several less invasive options — some you can do at home, one that uses a simple blood draw, and one that uses a CT scan. Here is a plain-English tour of what is covered, who qualifies, and what it may cost.

The yearly stool test (FOBT)

The screening fecal occult blood test (FOBT) is the oldest at-home option. Medicare Part B covers it once every 12 months for people aged 45 or older, as long as you have a referral from a doctor, physician assistant, nurse practitioner, or clinical nurse specialist. You collect a small stool sample at home and send it to a lab. If your provider accepts assignment, you pay nothing.

The stool DNA test every three years

Medicare also covers an at-home multi-target stool DNA test (you may know it by brand names) once every three years. To qualify, you must be between 45 and 85, have no symptoms of colorectal disease, and be at average risk. "Average risk" has a specific Medicare definition: no personal history of adenomatous polyps, colorectal cancer, or inflammatory bowel disease, and no family history of colorectal cancer, adenomatous polyps, familial adenomatous polyposis, or hereditary nonpolyposis colorectal cancer. If you meet those criteria and your provider accepts assignment, there is no cost.

A blood-based screening test

A newer option is a blood-based biomarker test for colorectal cancer. When available, Medicare Part B covers this once every three years for people aged 45 to 85 who have no symptoms and meet the same average-risk definition described above. This can be appealing if you have had difficulty with stool collection or want a simple blood draw at a lab. Again, no cost when the provider accepts assignment.

CT colonography (the "virtual colonoscopy")

Starting in 2025, Medicare added screening CT colonography as a covered benefit for people 45 or older when ordered by a doctor, physician assistant, nurse practitioner, or clinical nurse specialist. The scan uses a CT machine rather than a scope. Coverage is:

• Once every 24 months for people at high risk, and
• Otherwise once every 60 months, or once every 48 months if you previously had a flexible sigmoidoscopy or colonoscopy.

When your provider accepts assignment, there is no cost. The same rule change removed the barium enema as a covered screening method, so CT colonography largely replaces it.

Keep in mind that CT colonography still requires bowel prep. Its main advantage is avoiding sedation and the scope itself — not avoiding the prep.

Flexible sigmoidoscopy

Flexible sigmoidoscopy is another option that examines part of the colon with a shorter scope. Medicare covers it for people 45 or older, generally 48 months after a previous flexible sigmoidoscopy or CT colonography, or 120 months after a screening colonoscopy for those not at high risk. If a lesion or growth is removed during the procedure, you pay 15% of the Medicare-approved amount in 2026 (plus a 15% facility coinsurance in a hospital outpatient setting or ambulatory surgical center), with no Part B deductible. Federal regulations reduce that patient share to 10% for 2027 through 2029.

What happens if a stool or blood test is positive

This is an important point many people miss. If a Medicare-covered stool-based or blood-based screening test comes back positive, the follow-on colonoscopy counts as part of a complete colorectal cancer screening. That means no cost-sharing, and it is not subject to the usual colonoscopy frequency limits. In other words, choosing a less invasive first step does not create a cost trap if you need the scope afterward.

How these screenings fit with your Medicare coverage

Colorectal cancer screenings are Part B preventive services. If you have Original Medicare, these services are covered as described above. If you have a Medicare Advantage plan, the plan must cover the same preventive screenings, though provider networks and referral processes can differ.

When weighing coverage choices more broadly, Original Medicare paired with a Medigap policy and a stand-alone Part D plan offers broad provider access and more predictable out-of-pocket costs through Medigap, in exchange for additional premiums. Medicare Advantage bundles coverage, often includes Part D, and may include extras, but typically uses networks and prior authorization. Neither is "better" — it depends on your priorities, providers, and budget.

Dates and dollars worth knowing

A few confirmed program-level numbers for context:

• The Part D out-of-pocket cap is $2,100 in 2026 and $2,400 in 2027.
• The most any Part D plan may charge as a deductible in 2027 is $700.
• The Part D base beneficiary premium for 2027 is $41.33 (used for the late-enrollment penalty calculation; actual plan premiums vary).
• Annual Enrollment runs October 15 – December 7, 2026, for coverage starting January 1, 2027.
• Social Security announced a 3.6% COLA for benefits payable beginning January 2027.

The 2027 Part B standard premium, Part B deductible, and IRMAA income brackets had not been announced as of this writing; CMS typically releases them in the fall.

If you have Medicaid or Extra Help, since 2025 you have a monthly Special Enrollment Period to move to Original Medicare with a stand-alone Part D plan, or to switch stand-alone plans. Full-benefit dual-eligible individuals can join an integrated D-SNP in any month.

What should you do next?

Talk with your clinician about which screening method fits your risk level, preferences, and medical history. For official coverage details, enrollment questions, or help comparing options, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227), available 24/7.