Does Medicare Cover Gynecology Services?

The National Cancer Institute defines gynecology as a field of medicine that focuses on diagnosing and treating diseases of the female reproductive organs. It is often grouped with obstetrics. Gynecology also focuses on other issues related to women’s health, like menopause, hormone problems, birth control, and infertility. Gynecology is not just for younger women, you still need it as you age. That’s why a number of important gynecology treatments are covered by Medicare.

As long as you have an OB/GYN who takes Medicare, you can get preventive women’s health care through Medicare Part B.There are no exceptions; all women who have Medicare Part B have benefits for gynecology. You should make use of these advantages! Remember that Medicare isn’t just meant to help you when you’re sick or hurt; it’s also meant to keep you from getting sick in the first place. 

Preventative Screenings

Medicare pays for Pap smears, pelvic checks, STI testing, and HPV screenings. Your medical history and any risk factors will determine how often you can get these preventive treatments. For women with no symptoms and low risk pap smears and pelvic exams are recommended once every 2 years. While women with a higher risk of cervical cancer, or women with a history of abnormal pelvic exams should go annually. Johns Hopkins University says that cervical cancer is more likely to be cured if it is found and treated early. Screening tests, like Pap smears and pelvic checks, can help find cells that aren’t working right and could lead to cancer. 

Pelvic Exams

During a pelvic exam, the reproductive systems, including the vagina, vulva, cervix, ovaries, uterus, rectum, and pelvis, are examined physically. During a pelvic exam, your doctor may look for problems, do a Pap and/or HPV test, and look at your medical history.

Pap smears look for signs of cancer in the cervix. The doctor takes a few cells from your cervix with a small tool that looks like a spatula. The sample is then sent to a lab where it is checked for precancerous cells or other problems. If the doctor can find pre-cancerous cells early, you can get treatment before the cancer gets worse. Medicare Part B pays for Pap tests and pelvic exams once every 2 years to check for vaginal and cervical cancers. If you are at high risk, Medicare will pay for these tests once every 12 months. If you do any of the following, you may be in the high-risk group:

• If you have had an abnormal pap smear result in the last 3 years
• Were sexually active before your turned 16
• Have had more than 5 sexual partners throughout your life
• Have a history of or currently have an STD

As long as you meet the standards to get these services and get the annual checks, they are free. All of the tests, including the Pap check, lab work, a pelvic exam, and a breast exam, are free. Only if you go to a doctor who does not accept Medicare assignment will you have to pay for these services.

Mammograms

Mammograms are the best way to detect breast cancer. Original Medicare Part B pays for some preventive services, like mammograms, but there are rules you need to know before you schedule one. 

Types of Mammograms Covered By Medicare

First of all, Medicare covers 3 types of mammograms:

• Baseline mammogram – The first mammogram you get is called a baseline mammogram. It is used to look for early signs of breast cancer and will be compared to other scans in the future.
• Screening mammogram – Mammograms used for screening are preventive tests that look for new signs of breast cancer. They are usually done once a year on women over 40 who have no symptoms or signs of breast cancer and are thought to have an average risk of getting it.
• Diagnostic mammogram – A diagnostic mammogram is used to find out more about something wrong with the breast tissue, like a lump or a growth. To check for breast cancer, an x-ray of the breast will be taken. Diagnostic mammograms can also be used to find out more about a possible risk that was found during a screening mammogram.

How Often Medicare Covers Mammograms

The next thing you need to know is how often Medicare will cover a mammogram. Medicare will pay for one baseline mammogram for a woman between the ages of 35 and 39. Women over 40 are covered for a screening mammogram once every 12 months. Medicare will pay for as many screening mammograms as you need if they are deemed medically necessary.

Cost Of Medicare Covered Mammograms

Part B pays 100% of the Medicare-approved amount for baseline and yearly screening mammograms if your doctor or health care provider accepts assignment. That means you pay nothing (no deductible or coinsurance) for one baseline mammogram between the ages of 35 and 39, and you pay nothing for one screening mammogram every year if you are 40 or later.

If you get your mammogram from a participating provider, Medicare will pay 80% of the Medicare-approved amount. After you pay your Part B copay, you pay a 20% coinsurance fee ($164.90 in 2023). What you pay out of pocket can depend on how much your doctor charges and what other insurance you may have.

Do You Need A Pap Smear, Pelvic Exam, Or Mammogram After You Turn 65?

Even for older adults, Pap tests are an important way to check for cervical and vaginal cancers. Even if you are 65 years old, you may still be at risk for cervical cancer or vaginal cancer, so you should keep getting Pap tests until your doctor tells you to stop. Pap tests are no longer necessary after age 65 if:

• You’ve have 3 consecutive negative pap results
• You’ve have 2 negative pap-HPV tests in a row

On the other hand you definitely need to continue Pap smears if:

• You have a medical history of lesions of cervical cancer
• You were given DES, a synthetic estrogen hormone, during a pregnancy 
• If you have a weakened immune system

Even if you don’t need Pap smears anymore, gynecology exams are still a good way to check for health problems, especially if you are still sexually active. Regular pelvic checks in older people can help find more than just vaginal cancer. They can also help find sexually transmitted infections (STIs) and other changes in the vagina, rectum, or abdomen that aren’t normal. Also, the CDC says that most cases of breast cancer are found after the age of 50. Since Medicare covers both a breast exam and a pelvic exam, it is very important that you make sure your doctor gives you regular breast checks after you turn 65.

Which Parts Of Medicare Cover Gynecology?

Medicare will pay for appointments with an OB-GYN. But that’s not always the case. As is usually the case with Medicare, you have to meet certain requirements for Medicare to pay for your trips to the OB-GYN. We’ll explain what these are below so you know what to expect.

Original Medicare

Gynecology exams are covered by Original Medicare, which is made up of Medicare Parts A and B cove. Medicare Part B covers the cost of a visit to an OB-GYN. Medicare Part B pays for OB-GYN treatments like pap smears, pelvic exams, and breast exams. Once every 24 months, Medicare Part B pays for the above-mentioned services,ut Medicare Part B may pay for these tests once a year if you are at high risk of cervical or vaginal cancer or if you are of childbearing age and have had a negative pap smear in the last 3 years. During the tests, if your doctor finds a new or existing problem and has to treat it, that care would is diagnostic care, and Medicare Part B could send you a bill for it. 

Medicare Advantage

Medicare Advantage plans (Medicare Part C) also covers OB-GYN visits. By law, they must pay for everything Original Medicare pays for. But these plans also cover a wider range of health care treatments. Different plans will cover different services and charge different amounts for these services and the plan itself.  

EZ Can Help

Original Medicare covers most of the health care needs of women, which is good news. But Medicare Advantage and Medicare Supplements can add to the benefits you get from Original Medicare. Our licensed agents can help you find more health benefits through Medicare Advantage or more cash benefits through Medicare Supplements. Talk to an EZ agent who can tell you what you need to do to sign up and explain everything to you.

EZ can help you sign up, buy a Medicare Supplement Plan, or just think about your choices. Our insurance brokers work with the best firms in the country. You can get a free review of all the plans in your area from them. We’ll talk with you about your medical and financial needs and help you find a plan that meets them all. Call one of our agents at 877-670-3602 or enter your zip code in the bar below to start.