Does Medicare cover Pap smears and pelvic exams?

What does Medicare cover for cervical and vaginal cancer screening?

Medicare Part B covers Pap tests and pelvic exams, which check for cancer in the cervix and vagina. As part of a Pap test, Part B covers Human Papillomavirus (HPV) tests, and as part of the pelvic exam, Part B covers a clinical breast exam to check for breast cancer.

CMS describes a screening Pap test as a lab test used to detect early cervical cancer, for which a health care provider collects a cervical cell sample, and a screening pelvic exam as one that helps detect precancers, genital cancers, infections, sexually transmitted infections (STIs), reproductive system abnormalities, and other genital and vaginal problems. CMS says Part B covers these screenings when they're ordered and performed by one of these professionals authorized under state law: a doctor of medicine or osteopathy, a certified nurse-midwife, a physician assistant, a nurse practitioner, or a clinical nurse specialist.

How often does Medicare cover a Pap smear and pelvic exam?

Part B covers these screening tests once every 24 months in most cases. If you're at high risk for cervical or vaginal cancer, or if you're of child-bearing age and had an abnormal Pap test in the past 36 months, Part B covers these screening tests once every 12 months.

CMS's rules for providers count the timing from your last covered screening: at least 23 months after the most recent screening Pap test or pelvic exam on the every-24-months schedule, and at least 11 months after it on the yearly schedule. Part B covers the HPV test, as part of a Pap test, once every 5 years if you're between 30 and 65 and don't have HPV symptoms.

What counts as high risk for cervical or vaginal cancer?

CMS's rules for providers say the yearly schedule applies when there's evidence, based on your medical history or other findings, that you're at high risk for developing cervical or vaginal cancer and your doctor or other authorized practitioner recommends testing more often than every 2 years, or when you're of childbearing age and had a screening Pap test or pelvic exam during any of the previous 3 years that showed cervical or vaginal cancer or another abnormality. CMS lists these high risk factors for cervical and vaginal cancer:

• Early onset of sexual activity (under 16 years old).
• Multiple sexual partners (5 or more in a lifetime).
• A history of a sexually transmitted infection (including HIV infection).
• Fewer than 3 negative Pap tests, or no Pap tests, within the previous 7 years.
• Being a DES-exposed daughter of a woman who took diethylstilbestrol (DES) during pregnancy.

What do I pay for a Pap smear with Medicare?

If your doctor or other health care provider accepts assignment, you pay nothing for the lab Pap test, the lab HPV test with the Pap test, the Pap test specimen collection, and the pelvic and breast exams. CMS says it waives the coinsurance or copayment and the Part B deductible for the Pap test, pelvic exam and HPV screening when the service meets all coverage conditions, but a charge could apply if you see a non-participating provider.

Your doctor may recommend services that Medicare doesn't cover, or more often than Medicare covers them, which could mean extra costs for you, so ask what Medicare will cover.

Does Medicare also cover mammograms?

Yes, under their own Part B rules. Mammograms are x-ray pictures of the breast that check for breast cancer. Medicare Part B covers a screening mammogram once every 12 months if you're a woman 40 or older, and a one-time baseline mammogram if you're a woman between 35 and 39, and you pay nothing for baseline and screening mammograms if your provider accepts assignment. See what Medicare covers for mammograms.

Does Medicare Advantage cover Pap smears?

Medicare Advantage Plans must cover all medically necessary services that Original Medicare covers, and plans may also offer extra benefits that Original Medicare doesn't cover. Plans may have different out-of-pocket costs for certain services and may require you to use providers in the plan's network for non-emergency care, so check with the plan about where to get the screening. See how Medicare Advantage differs from Original Medicare.