Does Medicare cover annual gynecological exams?

Gynecological and reproductive health is essential even after child-bearing years, but the cost of tests and screening can be overwhelming. Does Medicare cover annual gynecological exams? Medicare Part B will cover a breast exam, pelvic exam, and Pap smear test once every 24 months. Read more about Medicare gynecological coverage below.

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D. Gilson is a writer and author of essays, poetry, and scholarship that explore the relationship between popular culture, literature, sexuality, and memoir. His latest book is Jesus Freak, with Will Stockton, part of Bloomsbury’s 33 1/3 Series. His other books include I Will Say This Exactly One Time and Crush. His first chapbook, Catch & Release, won the 2012 Robin Becker Prize from Seve...

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Leslie Kasperowicz holds a BA in Social Sciences from the University of Winnipeg. She spent several years as a Farmers Insurance CSR, gaining a solid understanding of insurance products including home, life, auto, and commercial and working directly with insurance customers to understand their needs. She has since used that knowledge in her more than ten years as a writer, largely in the insuranc...

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Reviewed by Leslie Kasperowicz
Farmers CSR for 4 Years

UPDATED: Jan 12, 2022

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The Highlights

  • Medicare Part B will cover a breast exam, pelvic exam, and Pap smear test once every 24 months
  • Medicare will also cover tests for HPV and screening mammograms
  • Unless these tests are diagnostic or you use an out-of-network provider, you will not need to pay out-of-pocket expenses, such as your deductible or copayment or coinsurance

Gynecological and reproductive health is important even after child-bearing age. Getting regular tests and screening can help prevent or diagnose certain disorders and diseases, but having health insurance to help with the cost is also important.

Does Medicare cover annual gynecological exams? How often can you seek out preventative care for breast, cervical, and vaginal cancer screenings among other illnesses? We’ll answer these questions below.

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Does Medicare cover annual gynecological exams?

Medicare Part B covers an annual Wellness visit with your primary physician. This includes a breast exam, pelvic exam, and a Pap smear. While the Wellness visit is covered once every 12 months, the gynecological portions are covered once every 24 months.

How Medicare Helps Cover Gynecological Care

You can also opt to have the gynecological portions of your Wellness exam performed by your gynecologist rather than your primary doctor. You will just need to make sure that your doctor marks them as deferred during your regular Wellness exam.

If you have an abnormal Pap smear or are at risk of cervical or vaginal cancer, Medicare will cover a gynecological exam once every 12 months.

If you see an in-network provider for these exams, you do not pay any out-of-pocket expenses, including your health care deductible and copayment or coinsurance. However, if your doctor begins diagnostic testing for symptoms that are noticed during your exam, you may have to pay your deductible and copayment or coinsurance for the tests.

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What other gynecology services does Medicare cover?

Medicare will also cover an HPV test every five years for those between the ages of 30 and 65. This is included in your Pap smear test.

If you are between the ages of 35 and 39, Medicare will cover a screening mammogram one time, and then every 12 months after the age of 40.

The same expense rules apply to these tests: you will not have to pay any out-of-pocket expenses as long as you choose an in-network provider that accepts assignment.

If you need a diagnostic mammogram rather than a screening mammogram, you may need to pay your deductible and copayment or coinsurance. However, Medicare may cover them more frequently than every 12 months.

Conclusion

Medicare Part B will cover a breast exam, pelvic exam, and Pap smear test once every 24 months (or 12 months if you have an abnormal Pap smear within the last 36 months). You will not have to pay any out-of-pocket expenses for these as long as you use an in-network provider.

Medicare will also cover HPV tests and screening mammograms without out-of-pocket expenses. If your doctor orders diagnostic testing, you may need to pay your deductible and copayment or coinsurance.

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