Are annual gynecological exams covered by Medicare?
Does Medicare cover annual gynecological exams? For eligible women, yes. Medicare Part B guidelines allow for a pelvic exam, pap smear, and breast exam every 24 months. However, if you are of childbearing age and have had an abnormal pap smear within 36 months, or your doctor considers you at high risk for cervical cancer, Medicare might pay for an exam every 12 months.
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UPDATED: Dec 6, 2021
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- Medicare Part B covers pelvic exams, pap smears, and breast exams, usually once every 24 months
- Gynecologists suggest that women over 65 should still get pelvic exams and pap smears to protect their health
- A Medicare Advantage plan might offer additional coverage over Original Medicare
Gynecological exams are of paramount importance when it comes to women’s health. Pap smears and breast examinations help detect early signs of cancer, as well as a host of other reproductive issues.
Health insurance pays for the majority of gynecological services you might need.
However, some women wonder if Medicare covers gynecological services. If you’ve been wondering, “Does Medicare cover gynecology exams?” the answer is yes, regardless of your age. However, Medicare doesn’t cover all gynecological services.
When does Medicare cover annual gynecological exams? You’ll need the right insurance for full coverage, but you can find affordable rates by shopping around. If you’re ready to see what quotes might look like for you, enter your ZIP code into our free tool today.
Does Medicare cover annual gynecological exams?
Medicare covers medical procedures and treatments that are medically necessary for your health. Since gynecological exams are vital in the detection of life-threatening health conditions, they fall under Medicare coverage.
Pap smears, pelvic exams, and breast exams are crucial in detecting breast and cervical cancer. Additionally, pelvic exams check for:
- Ovarian cysts
- Other abnormalities
Women usually get a Health insurance and pap smear annually or biannually. However, if you are experiencing pain, have unusual discharge or bleeding, or have urinary issues, your gynecologist will want to do an exam.
Medicare does cover gynecology exams through Part B. Part B covers outpatient services like doctor appointments, preventative health services, and diagnostic tests.
However, if you need more gynecological care than Medicare will cover, you can purchase supplemental insurance, known as Medigap.
Do you need pelvic exams after age 65?
Gynecologists recommend that women over the age of 65 continue to get pelvic exams. Even after the age of 65, women are still at risk of developing cervical or vaginal cancer. No matter what age, women should get a pelvic exam until their doctor says it’s no longer necessary.
Additionally, women over 65 are still likely to have other reproductive system issues. A pelvic exam alerts your doctor to infections, developing masses, or the presence of cysts on ovaries.
Ovarian cysts are especially important to look out for, as they can rupture and cause tremendous pain. If left untreated, ovarian cysts can be fatal.
How often does Medicare pay for gynecological exams?
For typical patients, Medicare will cover a pelvic and breast exam every 24 months. However, you may be eligible for an exam every 12 months if:
- You are of childbearing age (typically considered ages 15-49) and have had a pap smear with an abnormality within 36 months.
- You are considered high-risk for cervical or vaginal cancer.
Wondering if you’re at a higher risk for cancer? You should go over your risk factors with your gynecologist, but you can start with the following common risks:
- You’ve had five or more sexual partners.
- You became sexually active before the age of 16.
- You’ve had an STI.
- Your mother took diethylstilbestrol (DES) while she was pregnant with you.
- It’s been more than seven years since your last pap smear.
If these risk factors apply to you, Medicare will probably approve a pelvic exam every 12 months.
How much does a gynecological exam cost with Medicare?
Medicare encourages people to embrace preventative care. After all, the more preventative care you receive, the less likely you are to end up needing expensive emergency care.
In that vein of thought, your annual (or biannual) pelvic and breast exam will cost you nothing. Original Medicare covers the entire cost of the procedure.
Medicare Advantage offers the same coverage for gynecological exams. Since Medicare Advantage has to offer at least what Original Medicare does, you’ll still have free pelvic exams with an Advantage plan. However, Advantage plans may have different copay and coinsurance amounts.
However, one thing to keep in mind is that you do have to pay for diagnostic services. If your doctor finds something during your exam that needs care services, you might receive a bill from Medicare.
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Find the Best Medicare Health Insurance for Gynecologist Exams
While Medicare Part B covers your basic gynecological care, you can always add additional coverage through Medicare Advantage or Medigap. Even if you’re over 65, you still need to have pelvic exams and pap smears to stay healthy.
So, does Medicare cover annual gynecological exams? Medicare Part B does, but you should shop around for the best rates if you’re interested in Medicare Advantage. If you want to get a sense of what quotes might look like for you, enter your ZIP code into our free tool.