Colorectal cancer (CRC) is the fourth most frequently diagnosed cancer in the United States. CRC incidence rates in Northeast Texas, a primarily rural region of the state, far exceed state and national averages. The current study sought to determine the proportion of polyps found in a sample of 5,391 individuals living in Northeast Texas using either colonoscopy or fecal immunochemical testing. In addition, the role of insurance to CRC screening was also investigated. An adenomatous polyp was detected in 44.7% participants in the colonoscopy group and in 2.6% of participants undergoing FIT testing. Additionally, participants in the colonoscopy group who were un- or under-insured were 30% more likely to have an adenomatous polyp detected. While a larger proportion of participants had an adenomatous polyp detected in the colonoscopy group, many including the un- or under-insured are not able to afford, at which point FIT testing may be a better option.