Does Medicare cover Pap Smears, Pelvic, & Breast Exams?
Key Takeaways
- Medicare Part B covers Pap smears, pelvic exams, and breast exams once every 24 months.
- In women who have a higher risk of certain cancers, Medicare will cover a Pap smear, pelvic exam or breast exam once every 12 months.
- Medicare beneficiaries do not have to pay copayments, coinsurance, or deductible costs associated with these preventive tests.
Original Medicare, the federal health insurance program for people who are over 65 or have certain disabilities, covers Pap smears, pelvic exams, and breast exams in specific circumstances. Medicare Part B – the part of Original Medicare that provides medical insurance – covers these preventive services once every 24 months.
People who are at high risk for cervical,vaginal, or breast cancer may be eligible for a covered exam every 12 months. For beneficiaries aged 30-65, Medicare also covers tests for human papillomavirus (HPV) as part of a Pap smear once every five years.
We’ll discuss why these screenings matter for your health, how Medicare pays for them, and coverage for related services.
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What’s Your Why?
Before we dive into the details of Medicare coverage, let’s start by talking about why you might want to get a Pap smear, pelvic exam, or breast exam.
These common services can detect early signs of cancer, like cervical cancer or breast cancer. While cervical cancer is most common from age 35-44, about one in five cases each year are found in someone 65 or older. Breast cancer is most common in middle and older age, with a median diagnosis age of 62.
Regular screenings can help your doctors identify the risks of these cancers early and, if necessary, give you the best chance at successful treatment.
How Medicare Covers Pap Smears, Pelvic Exams, and Breast Exams
Medicare Part B covers Pap smears, pelvic exams, and breast exams as preventive services to check for cancer. These screenings are covered every 24 months for most beneficiaries. People who are at high risk may be covered every 12 months.
Let’s look at exactly what’s covered and why these tests matter.
Does Medicare Cover Pap Smears?
Medicare Part B covers Pap smears as a preventive service. In a Pap smear, your healthcare provider uses a small brush to collect cells from the cervix. They then look through a microscope for signs of cervical cancer or changes in the cells that could eventually result in cancer.
Testing regularly can lead to an early diagnosis and better opportunities for treatment. Medicare will pay for a Pap smear every 24 months for most beneficiaries or every 12 months if you are at high risk for cervical cancer. If you’ve received an abnormal Pap smear result in the past 36 months, you can have a Pap smear covered every 12 months.
Necessity of Pap Smears After 65
Medical guidance for Pap smears suggests that getting this test usually isn’t necessary after the age of 65. However, some experts recommend continuing to test since people over 65 can still have cervical cancer.
Your healthcare provider can help you decide when it makes sense to stop getting Pap tests. If you are 65 and older and have had at least three “normal” or “negative” Pap smear results in the past 10 years, your doctor may advise you to stop. On the other hand, Medicare will cover Pap smears every two years if you want to continue, and the screening is low risk.
Does Medicare Cover Pelvic Exams?
Medicare Part B covers pelvic exams as a preventive service. During a pelvic exam, a medical professional physically examines the reproductive system to look for signs of disease, lumps, or abnormalities. Medicare will pay for a pelvic exam every 24 months, or once a year if you’re at high risk for cervical or vaginal cancer.
Necessity of Pelvic Exams After 65
Some guidance says that you can stop getting pelvic exams after 65. However, pelvic exams can check the health of organs and while the chance of cancer in the pelvic organs may lessen with age, problems still happen.
Gynecologists may spot concerns like bladder and bowel problems, pain and sexual dysfunction, and pelvic organ prolapse. Pelvic exams are a low-risk service that can potentially prevent big health problems.
Does Medicare Cover Breast Exams?
Medicare covers clinical breast exams as a preventive service through Part B. In a breast exam, a medical professional feels for lumps or other changes in your breasts that might indicate a developing health problem like cancer. Medicare pays for breast exams every 24 months or, for high-risk individuals, every year.
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How Medicare Covers OB/GYN Visits
Many people stop seeing their OB/GYN entirely after the age of 65, but these visits can still be valuable for catching serious health issues. Medicare covers common OB/GYN services, including:
- Pap smears every 24 months
- Pelvic exams every 24 months
- Breast exams every 24 months
- Mammograms every 12 months for people over 40
- HIV screening once per year for people 15-65 or at high risk
- Testing for sexually transmitted infections every 12 months
Medicare may cover services more frequently if you are at high risk for a related health issue. Because these are preventive services, you don’t pay anything for them.
For conditions that require more visits or services from the OB/GYN, Medicare Part B will typically still pay, but you may be responsible for costs such as a copayment, coinsurance, or your deductible.
How Medicare Advantage Covers Pap Smears, Pelvic Exams, and Breast Exams
Medicare Advantage plans are a private insurance substitute for Medicare Parts A and B. They cover everything included in Medicare Parts A and B and may offer additional benefits.
Since Pap smears, pelvic exams, and breast exams are covered by Medicare Part B, they are also covered under all Medicare Advantage plans. In fact, more frequent screenings might be covered on some plans.
Medicare Advantage plans and the benefits they offer are specific to your ZIP code. Check what plans are available from private insurance carriers in your area to learn about the details of covered OB/GYN services.
How Much Pap Smears, Pelvic Exams, and Breast Exams Cost With Medicare
Medicare coverage can help you save money on healthcare, but it isn’t free. Part B charges a monthly premium, and most people who switch to Medicare Advantage plans still have to pay the Part B premium. For many services, you will also be charged a coinsurance or copayment.
See below for the likely out-of-pocket costs of pap smears, pelvic exams, and breast exams comparing the costs of these services on Original Medicare with a Medicare Advantage plan and going without coverage.
Pap Smear | Pelvic Exam | Breast Exam | |
Original Medicare | $0 | $0 | $0 |
Medicare Advantage | $0 | $0 | $0 |
No insurance | $39-125 | $150 | $0* |
*Many organizations at the federal, state, and private level offer free or low-cost breast screenings for those without insurance
Costs may vary based on your plan’s healthcare provider network, your region, plan details, etc.
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Find Plans Today Other Benefits to Consider
- Mammogram: Mammograms are recommended yearly for breast cancer screening at age 40 and older. Medicare covers a screening mammogram once every 12 months and diagnostic mammograms when medically necessary.
- Sexually Transmitted Infection (STI/STD) Screening: Medicare covers STI screening for chlamydia, gonorrhea, syphilis, and Hepatitis B if your healthcare provider orders it. This screening is covered once a year at no cost if your provider accepts Medicare.
- Chemotherapy: If you’re diagnosed with cancer, your doctor may recommend chemotherapy. Chemotherapy is covered by Medicare, but may require a copayment or coinsurance depending on the setting where you receive the treatment.
- Radiation: Radiation is another common treatment for cancer. Medicare covers radiation, although you might have to pay a 20% coinsurance.
Putting It All Together
Keeping up with your preventive healthcare can help you catch problems early and prevent serious consequences. Medicare fully covers screening services such as pap smears, pelvic exams, and clinical breast exams, so you won’t have to pay a copay or coinsurance. Pay attention to how often Medicare will pay for these services; for most people, it’s once every 24 months. If you’re considered high risk, Medicare may cover these screenings once a year.
Sources
Cervical & vaginal cancer screenings. Medicare.gov.
Key Statistics for Cervical Cancer. American Cancer Society.
It’s time to re-evaluate cervical cancer screening after age 65. Gyneocologic Oncology.
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