"How much does Cologuard cost in 2026?"

"Cologuard's list price is $649 for the test itself. Medicare covers it every 3 years for patients 45–75 at average risk, with $0 patient cost-sharing. Most major commercial insurance plans also cover it at no cost. Without insurance, you pay the full $649 — and if your result is positive, you'll also need a follow-up colonoscopy costing $1,500–$3,500."

"Does Medicare cover Cologuard?"

"Yes. Medicare covers Cologuard as a colorectal cancer screening test once every 3 years for beneficiaries aged 45–75 who are at average risk and show no symptoms. Under Part B preventive coverage, your cost is $0 — no deductible, no coinsurance. A positive Cologuard result leading to a colonoscopy may have cost-sharing depending on your supplement plan."

"What happens if Cologuard comes back positive?"

"A positive Cologuard result means a follow-up colonoscopy is required. That colonoscopy is diagnostic, not preventive — so depending on your insurance plan, it may be subject to your deductible and coinsurance. Without insurance, expect $1,500–$3,500. Your insurer may waive cost-sharing if polyps are removed. Check your specific plan language before the colonoscopy."

Cologuard Cost 2026: $649 List Price — What Insurance Actually Pays

📋 Data from Medicare fee schedules & FAIR Health ✓ Reviewed by board-certified gastroenterologist 🔄 Updated May 2026

Here’s something Cologuard’s commercials don’t mention: about 1 in 7 people who take it and don’t have cancer will get a positive result. That means a follow-up colonoscopy — which costs $1,500–$3,500 without insurance and may not be covered as preventive care even with insurance.

That doesn’t make Cologuard a bad test. It makes it a test you should understand financially before you order it.

What Cologuard Actually Costs

Scenario	Cologuard Cost	Follow-Up Colonoscopy Cost
With Medicare (Part B)	$0	$0–$500 (varies by supplement)
With commercial insurance (in-network)	$0–$30 copay	$200–$1,500 (diagnostic, not preventive)
Without insurance (self-pay)	$649	$1,500–$3,500
Exact Sciences Patient Assist Program	Reduced or $0	Not covered by program

The $649 is the standard list price for the test, which you collect at home and mail to Exact Sciences’ lab in Madison, Wisconsin. There’s no doctor visit required for the test itself — just a prescription from your physician.

Medicare Coverage: The Gold Standard for Cologuard

Medicare is where Cologuard’s coverage is clearest. The Centers for Medicare & Medicaid Services covers Cologuard (HCPCS code G0464) as a colorectal cancer screening test:

Who qualifies: Average-risk beneficiaries aged 45–75 with no symptoms, no personal history of colorectal cancer or adenomas, no inflammatory bowel disease, no family history meeting high-risk criteria
Frequency: Once every 3 years
Patient cost: $0 — no deductible, no coinsurance under Medicare Part B preventive benefits

The 3-year interval matters. If you’re tested every 3 years from age 45 to 75, that’s about 10 tests — completely covered. By comparison, the screening colonoscopy interval for average-risk patients is every 10 years.

The Medicare False Positive Trap

If your Cologuard is positive and you need a colonoscopy, Medicare covers the colonoscopy — but as a diagnostic procedure, not a screening. That changes the cost-sharing. Patients on Original Medicare without supplemental (Medigap) coverage pay 20% of the Medicare-approved amount after meeting the Part B deductible ($257 in 2026). For a colonoscopy, that’s typically $300–$600. A Medicare Advantage plan may have a $0 copay — check your specific plan’s diagnostic colonoscopy benefit.

Commercial Insurance Coverage

Most major commercial plans (BCBS, Aetna, UnitedHealthcare, Cigna, Humana) cover Cologuard as a preventive benefit with no patient cost-sharing — like mammograms or blood pressure screening. Coverage has expanded since the USPSTF updated its colorectal cancer screening recommendations in 2021 to include Cologuard for average-risk adults 45–75.

What varies between plans:

Age requirement: Most start at 45, some at 50
Interval: Most cover every 3 years, matching the FDA labeling and USPSTF recommendation
Risk classification: “Average risk” must be documented. If you have a family history of colorectal cancer, you’re typically classified as high risk and Cologuard may not be the recommended test — colonoscopy usually is
Positive result follow-up: This is where it gets complicated. If Cologuard is positive, the colonoscopy is diagnostic. Many commercial plans waive cost-sharing for the follow-up colonoscopy, but not all. Always call your insurer before the colonoscopy to confirm how it’s classified.

Cologuard vs. Colonoscopy: The Real Cost Comparison

The commercials make Cologuard sound like the frugal choice. The math is more complicated.

Factor	Cologuard (Every 3 Years)	Colonoscopy (Every 10 Years)
Test/procedure cost (insured)	$0	$0 (preventive)
Total tests age 45–75	~10 tests	~3 procedures
False positive rate requiring colonoscopy	~13% per test	N/A
Lifetime false positive probability (10 tests)	~75% chance of at least one	N/A
Polyp removal during same session	No — requires separate colonoscopy	Yes — immediate

Here’s the key point: Cologuard detects cancer and large polyps, but it can’t remove them. A positive result always means a colonoscopy. A colonoscopy finds polyps and removes them in one session — no second procedure, no false positives.

The CDC estimates that colorectal cancer is the second-leading cause of cancer death in the US, with approximately 153,000 new cases diagnosed annually. The screening test you’ll actually use consistently is better than the perfect test you avoid.

Cologuard’s false positive rate is approximately 13% (about 1 in 7 negative patients get a positive result per test). After 5 tests over 15 years, the cumulative probability of at least one false positive is over 50%. Each false positive means a colonoscopy — with its prep, sedation, time off work, and cost. Factor this into your screening strategy conversation with your doctor.

Who Cologuard Is Right For

Cologuard is a good fit if:

You’re at average risk and 45–75 years old
You’re covered by Medicare or insurance that fully covers it
You have significant anxiety about colonoscopy sedation or prep
You have medical conditions that make colonoscopy higher risk (blood thinners you can’t stop, significant comorbidities)
You’ve been putting off colonoscopy — Cologuard you’ll actually do beats a colonoscopy you keep delaying

Cologuard is a poor fit if:

You have a family history of colorectal cancer (guidelines recommend colonoscopy starting at 40 or 10 years before the youngest affected family member)
You’ve had polyps before — you’re now high risk and need colonoscopy surveillance
You have symptoms (rectal bleeding, changes in bowel habits, unexplained weight loss) — that’s diagnostic territory, not screening

If You’re Uninsured: Exact Sciences Assistance

Exact Sciences offers a patient assistance program for uninsured or underinsured patients. Income-based eligibility can reduce cost to $0 or a nominal fee. Visit the Exact Sciences website or call their patient support line to apply — they process applications quickly and your doctor’s office can help with the paperwork.

The $649 list price is the worst-case number. Most people pay far less — or nothing.

Disclaimer: Cost figures are estimates for US patients based on 2025–2026 published fee schedules, Medicare data, and FAIR Health benchmarks. Actual costs vary by location, provider, plan, and procedure complexity. This site does not provide medical advice. Always verify costs with your provider before scheduling.