How much does a colonoscopy cost?

How much does a colonoscopy cost?

The price of a colonoscopy varies, all the way free to $2,000 or more. How much you pay will depend on how you get your colonoscopy:

• Medicare: If you're entitled to Medicare, a colonoscopy is free in a public hospital. However, waiting periods tend to be longer than if you choose to go private.
• Private health insurance: If you have hospital insurance that covers 'gastrointestinal endoscopy', a colonoscopy will be covered. Bronze tier hospital policies all cover this, as do many basic plus tier policies. According to the government's Medical Costs Finder database, 76% of private patients with health insurance had no out-of-pocket costs for colonoscopy. For the remaining 24%, the average gap was $180.
• Private hospital without insurance: If you don't have private hospital insurance but you get a colonoscopy at a private hospital, the price is likely to be around $2,000 all in, based on the data from Medical Costs Finder. This is pretty rare, but it can happen.

Are colonoscopies covered by Medicare?

Yes, Medicare covers the cost of colonoscopies. If you get treatment in a public hospital, you should be covered for 100% of the colonoscopy costs.

However, public hospitals have long waiting lists. Your appointment will likely be made months in advance and you won't have any say on the time, date or location.

Does private health insurance cover colonoscopies?

Yes. All hospital policies at bronze level or above cover medically necessary colonoscopies. You'll find it included under gastrointestinal endoscopy. Some insurers include it in their basic policies as well.

Remember though, private health insurance only covers 25% of the MBS fee while Medicare covers the other 75%. If your healthcare provider charges more than the recommended fee, you will have to pay the rest. This is called the gap.

According to the Medical Costs Finder, only 24% of private patients with private health insurance had to pay a gap fee for their colonoscopy. The typical cost was $180.

Bronze level hospital policies start at around $80 a month and provide cover for 21 clinical categories, including cancer treatment, joint replacement and diabetes management.

The importance of regular tests

"My grand-father had bowel cancer about 20 years before he died, so he had regular colonoscopies for the rest of his life. He got them at the local public hospital under Medicare, but even if he used private health insurance it would likely have been covered with no out-of-pocket fees. I'm not really old enough for it to be a worry for me yet, but I will eventually need to consider my family history."

Tim Bennett

Insurance expert

Out of pocket costs for colonoscopies

The government sets a price for hospital treatments, which it believes is fair. It's designed as a guide for healthcare professionals and is called the Medicare Benefits Schedule (MBS) fee.

However, healthcare providers don't have to stick to this price. For example, a certain procedure could have an MBS fee of $100 but a private doctor could easily charge $200.

If you go private, Medicare will only pay 75% of the MBS fee while health insurance pays the other 25%. If your doctor chooses to charge more than the MBS fee, you will have to pay that amount. This is referred to as the gap.

You can ask your doctor and private health insurer about these costs beforehand. If you want to avoid these costs, look for an insurer that provides gap cover as part of your policy.

This can help pay the difference between what your doctor charges and Medicare and private health insurance cover. If you can use a doctor who participates in your insurer's gap cover, you may be able to avoid paying any out of pocket expenses.

Waiting periods for colonoscopy

There are waiting periods for colonoscopy - you'll have to serve a waiting period of 2 months before you can make a claim. If you have a pre-existing condition that requires a colonoscopy, then you'll have to wait 12 months.

FAQ about colonoscopy costs

• Are there out of pocket costs for colonoscopies?

  Most Australians with private health insurance won't have any out of pocket expenses for a colonoscopy. Based on Medical Costs Finder data, only 24% of privately insurance patients pay a gap, with the average gap only being around $180. Note that you might need to pay your excess, depending on the rules and exemptions on your policy.

• Is a colonoscopy free in Australia?

  A colonoscopy is often free in Australia if you're eligible for Medicare. Additionally, as part of the National Bowel Cancer Screening Program, Australians from 50 to 74 years of age can get sent a free test that you can do at home.

Written by

Gary Ross Hunter

Editor, Insurance

Gary Ross Hunter was an editor at Finder, specialising in insurance. He’s been writing about life, travel, home, car, pet and health insurance for over 6 years and regularly appears as an insurance expert in publications including The Sydney Morning Herald, The Guardian and news.com.au. Gary holds a Kaplan Tier 2 General Advice General Insurance certification which meets the requirements of ASIC Regulatory Guide 146 (RG146). See full bio

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