At-Home Colon Cancer Tests: FIT vs. Stool DNA, and What Medicare Covers

Colon cancer screening doesn’t have to start with a colonoscopy. At-home stool tests you collect and mail back are a recommended option for people at average risk. The two main types work differently, though, and the fine print on coverage matters. Here is how they compare.

Who should be screened

The U.S. Preventive Services Task Force (USPSTF)¹ recommends colorectal cancer screening for adults 45 to 75. From 76 to 85, it suggests deciding case by case, based on your health, past screening and preferences.¹

The two at-home tests

	FIT (fecal immunochemical test)	Stool DNA test with FIT
What it looks for	Hidden blood in stool	Changes in DNA plus hidden blood
How often (USPSTF)	Every year1	Every 1 to 3 years1
Medicare	Every 12 months, age 45 and up2	Every 3 years, ages 45 to 85, if eligible3

The USPSTF notes that yearly stool DNA testing would lead to more follow-up colonoscopies than yearly FIT.¹ Both are options. Ask your clinician which fits your history and how reliably you’ll repeat it on schedule.

Who qualifies for a stool test

Medicare covers the stool DNA test only if you have no symptoms of colorectal disease, such as belly pain or blood in your stool, and you’re at average risk. That means no personal history of polyps, colorectal cancer or inflammatory bowel disease, and no family history of colorectal cancer or adenomatous polyps.³

If you have symptoms or a higher risk, a home kit isn’t the right tool. Talk with your clinician about a colonoscopy instead.

What a positive result means

A positive stool test isn’t a diagnosis, but it does mean you need a colonoscopy. The USPSTF says abnormal stool test results need follow-up with colonoscopy.¹ Our article on questions after a positive FIT covers next steps.

The cost of that follow-up

Medicare counts a colonoscopy after a positive stool test as a screening test. If your provider accepts assignment, you pay nothing for the screening tests, including that follow-up colonoscopy.⁴

One catch: if a polyp or other tissue is removed during the colonoscopy, Medicare says you pay 15% of the approved amount for the doctor’s services, plus a 15% facility coinsurance in a hospital outpatient department or surgery center. The Part B deductible doesn’t apply.⁴

If you have private insurance, call your plan and ask the same questions before you test.

Before you order a kit

1. Get it through your clinician or plan, so results go into your record and the follow-up is arranged.
2. Ask who will call you with results and how fast a colonoscopy can be scheduled if it’s positive.
3. Follow the collection and mailing instructions exactly, so you don’t have to repeat it.
4. Set a reminder for your next test date.

Try: “I’m 58 with no family history and I’d rather not start with a colonoscopy. Is a FIT or stool DNA kit right for me, and what would I pay if it’s positive?”

Bloated by Dinner includes a Belly Clock log and a Test-It list with a visit script. Use them to note any bowel changes and your screening dates, and bring them to your appointment. See the book.