Does Medicare Cover Annual Gynecological Exams?

Medicare Benefits

Feb 12, 2023

Gynecologists perform Pap smears and pelvic exams to detect conditions like endometriosis, cysts, and fertility issues. Screenings detect cervical, vaginal, and ovarian cancer. Routine visits and screenings are covered under Medicare Part B preventive services with specific parameters around age and risk.

• Every 24 months in the majority of cases
• Every 12 months if one of these applies: You have high-risk factors for contracting cervical or vaginal cancer, or you are of childbearing age with a history of abnormal Pap test results within the last 36 months. 
• Every five years for a Human Papillomavirus (HPV) test, as part of the Pap test, if you are between the ages of 30 and 65 and present no symptoms

TIP: Did you know that you can use our plan finder to discover Medicare plans that include more of the women’s health services you need? Or, call today to speak with a Licensed Sales Agent who can answer your Medicare questions: 877-882-1927.

How Often Does Medicare Cover Breast Cancer Screening?

Women’s gynecological health is important at any age. Even after a woman’s reproductive years have passed, annual wellness visits can be essential in recognizing changes in your health. Addressing concerns and making an early diagnosis can affect the potential for positive outcomes. 

As part of a regular women’s wellness exam, your gynecologist examines your breasts to check for lumps or other signs of breast cancer. Preventive breast exams are covered when performed during the same visit as the pelvic exam.

Another preventive measure for breast cancer screening is imaging, such as a mammogram. Depending on your breast density, your gynecologist may also recommend an ultrasound. If the medical practice is not equipped to perform imaging, you may be referred to another healthcare facility, such as the outpatient department of a hospital.  

If you are between ages 35 and 39, Medicare covers one mammogram as a baseline or reference point to compare against future screenings. If you are age 40 or over, you are eligible for an annual mammogram.

If you meet the eligibility criteria and your doctor accepts assignment, you do not have to pay deductibles, copayments, or coinsurance for the lab tests and screening exams. Medically necessary diagnostic mammograms, which may be more frequent than once per year, require the Part B deductible and 20% coinsurance. 

TIP: Read our companion blog on Medicare coverage for annual physical exams.

Does Medicare Advantage Cover Pelvic Exams and Mammograms?

Medicare Advantage (MA) is an option provided by private insurance companies. Medicare Advantage offers the benefit of having the different parts of Medicare under one roof, in some cases with coverage that extends beyond Original Medicare. MA plans include the same Parts A and B benefits as Original Medicare, but most also include Part D prescription drug coverage as well as additional benefits.

Under an MA plan, deductibles, coinsurance and copayments may differ from Original Medicare. You may be restricted to a network of healthcare providers depending on the type of MA plan you choose. Check your Evidence of Coverage to learn your benefit details and stipulations. The plan’s provider directory lists the providers contracted with the plan.  TIP: Discover 7 reasons why you might want to switch your Medicare Advantage plan.

Common Gynecological Services

When you check in at your gynecologist’s office, the visit usually begins with questions about your general health and concerns, measurement of your weight and height, and a request for a urine sample. 

Your doctor’s examination will generally entail the following, as applicable:

• Pelvic exam of internal and external organs that checks the health of the vagina, cervix, ovaries, uterus and fallopian tubes
• Pap test to check for precancerous cells in the cervix
• STI test to look for infections like genital herpes, syphilis, vaginitis, HIV and Hepatitis B
• Birth control discussion and options, including prescriptions and devices
• Evaluation and help with menstruation or menopause issues

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Does Medicare Cover Gynecological Exams if You’re Over 65?

Medicare does not place an age limit on cervical and vaginal cancer screenings, which are covered once every 24 months. 

The American Cancer Society (ACS) recommends that cervical cancer screening starts at age 25. Guidelines for the HPV test are every five years if you are between the ages of 25 and 65, either a primary HPV test (by itself) or a co-test (with a Pap test). If you are over 65 and have received normal results from your screenings over the past 10 years, you can stop cervical cancer screenings, according to the ASC. 

An exception will apply if you have been diagnosed with CIN2 (abnormal cells on the cervix surface) or a more severe diagnosis within the past 25 years. If you had a hysterectomy for cervical cancer or precancer, continue the screenings. Likewise, continue screenings if the cervix was not removed.

TIP: Discover if Medicare covers genetic testing for breast cancer.

How Do I Find a Gynecologist Near Me?

With Original Medicare, you can see any doctor across the United States who accepts Medicare patients. Medicare Advantage provider networks are not the same for every plan. 

TIP: If the doctor you want to see is not in your plan, you may find our plan finder tool helpful to start researching other Medicare options available in your area.