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 preventative tests.
A Pap test, also called a Pap smear, is a diagnostic test that can be used to detect cervical cancer. Medicare Part B covers Pap smears and pelvic exams as preventative services for cervical and vaginal cancers. Medicare pays for these Pap smears for as long as you and your doctor determine that they are necessary.
Under Medicare, you are covered for a Pap smear once every 24 months. [i] In some cases, you may be covered for a Pap test once every 12 months if you meet the following eligibility:
- You are considered at high risk for cervical cancer or vaginal cancer.
- You are of childbearing age and have had an abnormal Pap smear in the past 36 months.
You are regarded as high risk for cervical or vaginal cancer if you: [i]
- engaged in sexual activity before the age of 16.
- have multiple sex partners.
- have a history of sexually transmitted illnesses (STIs).
- have a lack of previous Pap tests.
- are the child of a woman who took diethylstilbestrol (DES) during pregnancy.
Pap tests are considered a preventative service under Medicare Part B, so you won’t pay a coinsurance, copayment or Part B deductible for this test. However, you may have to pay for some or all of the costs of your Pap test if you see a non-Medicare provider or decide to test more frequently than you are eligible.
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Medicare is government-funded health insurance for adults aged 65 and older and those with certain disabilities. Since most Medicare beneficiaries are above the age of 65, Medicare does continue to cover Pap smears after this age. Medicare Part B will continue to pay for these Pap smears after the age of 65 for as long as your doctor recommends them.
Is a Pap smear necessary after age 65?
Pap smears are an essential part of screening for cervical and vaginal cancers, even in older adults. Even after you turn 65, you may still be at risk of developing cervical cancer or vaginal cancer, so it is recommended to continue taking Pap tests until your doctor says to stop. According to the Centers for Disease Control & Prevention (CDC), you no longer need to have Pap smears after the age of 65 if: [i]
- you have had three normal Pap smears in a row within the previous 10 years.
- you have had two normal Pap-HPV co-tests in a row within the previous 10 years.
Screening for cervical and vaginal cancers should continue after 65 years of age for high-risk women, which includes those who:
- have a history of cervical cancer or lesions. [i]
- are the child of a mother who was given DES during pregnancy.
- have weakened immune systems.
Talk with your provider to learn more about how often you are covered for Pap smear tests.
A pelvic exam is a physical examination that can be used to detect infections, STIs, certain cancers, and other abnormalities. Under Medicare guidelines, a pelvic exam also includes a breast exam to screen for breast cancer. While Medicare does not pay for annual pelvic and breast exams, it does cover a comprehensive pelvic exam once every 24 months.
Medicare will cover a pelvic exam more frequently than 24 months in women who are high-risk for cervical or vaginal cancers. Under Medicare Part B, you will be covered for a pelvic exam once every 12 months if:
- you are considered at high risk for cervical cancer or vaginal cancer.
- you are of childbearing age and have had an abnormal Pap smear in the past 36 months.
You do not have to pay a coinsurance, copayments or deductible for a pelvic exam if you stay within the Medicare Part B testing guidelines. However, if you choose to get a pelvic exam more frequently than what Medicare will cover, out-of-pocket costs may apply.
Is a pelvic exam necessary after 65?
Even if you are over 65 and no longer need Pap smears, pelvic exams are an important screening tool for older women, especially those who are still sexually active. Regular pelvic exams in older adults can help diagnose more than just vaginal cancers — they can help detect STIs or other abnormal changes in the vagina, rectum, or abdomen.
In addition, according to the CDC, most breast cancer cases are diagnosed after age 50. [i] Since Medicare covers a breast exam in addition to a pelvic exam, it is vital to make sure that you are undergoing regular breast exams with your doctor after the age of 65.
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Pap smears, pelvic exams, and breast exams can be performed during a visit with your OB/GYN or, in some cases, your primary care provider. If you are considered high risk for cervical or vaginal cancers, your Medicare Part B plan will cover these services once every 12 months at your annual visit. If you are not high risk, Medicare will only cover these services once every 24 months.
Medicare will also cover the following preventative screening services under your Part B plan: [i]
- STI screening
- HIV screening
One important thing to note is that if you have a condition that requires more frequent visits to the OB/GYN, Medicare Part B will cover these preventative, diagnostic, or treatment services. [i] In this case, you will still be responsible for paying any out-of-pocket costs associated with these services, such as copayments, coinsurance and deductibles.
Medicare currently covers HPV testing once every five years in conjunction with a Pap smear test for beneficiaries aged 30 to 65. [i] Preventative HPV testing must be performed in conjunction with the Pap smear, which can be performed once every 12 or 24 months.
Unfortunately, current Medicare coverage does not cover HPV testing for beneficiaries above 65 years of age.
What extra benefits and savings do you qualify for?
Medicare Advantage plans are required to cover the same services as Original Medicare, although many offer additional coverage options. Since Medicare Part B only covers Pap smears and pelvic exams every 24 months, Medicare Advantage plans must follow the same coverage rules.