Medicare coverage of Pap smears, pelvic exams and physical breast exams

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Pap smears can detect cervical or vaginal cancer in its early stages. They can also screen for sexually transmitted diseases, fibroids, and various types of genital and vaginal problems including cancer. The pelvic exam includes a breast examination, which can help detect signs of breast cancer.

For women with Medicare who are considered at low risk for cervical or vaginal cancer, Original Medicare covers 100 percent of the cost of one Pap smear every two years (24 months). Medicare Advantage (MA) plans will cover all preventive services the same as Original Medicare. This means MA plans will not be allowed to charge cost-sharing fees (coinsurances, copays or deductibles) for preventive services that Original Medicare does not charge for as long as you see in-network providers. If you see providers that are not in your plan’s network, charges will typically apply.

For women who are of childbearing age and have had an abnormal Pap smear in the past 36 months Medicare covers the cost of one Pap smear a year (every 12 months).  Medicare will also cover a Pap smear once a year for women who are considered at high risk of developing cervical or vaginal cancer. Women are considered at high-risk for cervical or vaginal cancer if:

  • They were active sexually early (under 16 years of age)
  • They have had multiple sexual partners (5 or more)
  • They have had a sexually transmitted disease
  • Their  mother was given the drug diethylstilbestrol (DES) during pregnancy
  • They smoke
  • They have received fewer than three negative pap tests or no pap test during the past 7 years
  • They have used birth control pills for an extended period of time (5 years or more)

Original Medicare covers Pap tests (including collection), pelvic exams (used to help find fibroids or ovarian cancers), and clinical breast exams with no coinsurance or deductible if you see doctors or other health care providers who accept assignment. Doctors who accept assignment cannot charge you more than the Medicare approved amount. People with Medicare also do not pay for Pap lab test fees.


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Medicare.gov -- Search for Participating Physicians

American College of Obstetrics and Gynecology

National Directory of Medicare Regional Carriers and Intermediaries

Medicare.gov: National A/B MAC Information

 
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