Are Gynecological Exams Covered by Medicare?
Medicare covers Pap tests and pelvic exams to check for cervical and vaginal cancers at no cost to you. Clinical breast exams are also covered. You can receive these preventive screenings once every 24 months, or more frequently if you have certain risk factors.
Medicare Coverage and Costs of Preventive Screenings for Females
Cervical cancer and other cancers of the female reproductive organs often have no symptoms.
According to Johns Hopkins University, cervical cancer is more likely to be successfully treated if it is found early.
Screening tests such as Pap smears and pelvic exams can help find abnormal cells that may lead to cancer.
How often you can receive these preventive services depends on your medical history and any risk factors.
|Once every 24 months||Asymptomatic female patients|
|Once every 12 months||Female patients who have a medical history or other factors that put her at high risk for developing cervical or vaginal cancer. Also, women of childbearing age with an abnormal pelvic exam or Pap test within the last three years.|
Certain risk factors may qualify you to receive Pap tests and pelvic exams more frequently than once every 24 months.
- Early onset of sexual activity (before the age of 16)
- More than five sexual partners in a lifetime
- History of sexually transmitted disease
- Fewer than three negative Pap smears within the previous seven years
- Daughters of women who took DES during pregnancy
For Medicare to pay your claim, Pap smears and pelvic exams must be ordered and performed by a doctor, certified nurse-midwife, physician assistant, nurse practitioner or clinical nurse specialist.
You pay nothing for a Pap smear, pelvic exam or breast exam so long as your doctor accepts Medicare.
If your doctor recommends more frequent tests, you may owe a copayment or have other out-of-pocket costs.
Medicare Advantage plans also cover these screenings for women, although you will likely need to see a doctor or other provider in your plan’s network to receive coverage.
A Pap smear, also known as a Pap test, is a procedure to check for cervical cancer in women.
It involves collecting cells from your cervix using a soft brush and a flat scraping device called a spatula.
Pap tests can also find problems that aren’t cancer, such as abnormalities and infections.
Medicare coverage includes a separate test for the human papillomavirus, or HPV. This virus is the main risk factor for cervical cancer.
Any female Medicare beneficiary between the ages of 30 and 65 can receive an HPV screening test once every five years when a Pap smear is performed at the same time.
Medicare Part B covers a Pap smear once every 24 months. The test may be covered once every 12 months if you’re at high risk for cervical cancer or other female-related cancers.
You and your doctor can discuss the benefits and risks of Pap smears and decide what’s best for you.
Pelvic Exams and Clinical Breast Exams
During a pelvic exam, a doctor evaluates your reproductive organs.
A pelvic exam helps detect precancers, genital cancers, infections, STDs, reproductive system abnormalities and other conditions.
This exam is done in your doctor’s office and takes only a few minutes.
Your doctor may perform a pelvic exam and a breast exam at the same time as your Pap test.
A clinical breast exam is a way to check for signs of breast cancer or other abnormalities.
A breast exam involves a medical professional checking each of your breasts, underarms and your collarbone area for changes in skin texture or breast size.
Your doctor will also feel each of your breasts for any painful areas or lumps.
Medicare coverage of pelvic exams and clinical breast exams is similar to Pap smear coverage.
You can receive one pelvic exam every 24 months. The test may be covered once every 12 months if you’re at high risk for cervical cancer or other female-related cancers.
10 Cited Research Articles
- University of Michigan. (2020, December 17). Breast Exam. Retrieved from https://www.uofmhealth.org/health-library/tv7408#tv7412
- Centers for Medicare & Medicaid Services. (2020, December). Screening Pap Tests & Pelvic Exams. Retrieved from https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Screening-PapPelvic-Examinations.pdf
- United Healthcare. (2020, October 14). Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer (NCD 210.2). Retrieved from https://www.uhcprovider.com/content/dam/provider/docs/public/policies/medadv-guidelines/s/screening-pap-smears-pelvic-exam-detection-cervical-vaginal-cancer.pdf
- Mayo Clinic. (2020, June 25). Pap Smears. Retrieved from https://www.mayoclinic.org/tests-procedures/pap-smear/about/pac-20394841
- Centers for Disease Control and Prevention. (2020, June 8). Cervical Cancer Statistics. Retrieved from https://www.cdc.gov/cancer/cervical/statistics/
- Mayo Clinic. (2019, June 25). Pelvic Test. Retrieved from https://www.mayoclinic.org/tests-procedures/pelvic-exam/about/pac-20385135
- Centers for Medicare & Medicaid Services. (2006, June). National Coverage Determination (NCD) for Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer (210.2). Retrieved from https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=185&ncdver=2&bc=AAAAEAAAAQAA
- Johns Hopkins University. (n.d.). Pap Smear. Retrieved from https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/pap-test
- Medicare.gov. (n.d.). Cervical & vaginal cancer screenings. Retrieved from https://www.medicare.gov/coverage/cervical-vaginal-cancer-screenings
- University of Rochester Medical Center. (n.d.). Pap Tests for Older Women. Retrieved from https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=1&contentid=4574