Does Medicare Cover Mammograms and Other Women’s Health Services?
October 3, 2019
Reviewed and Updated by Anastasia Iliou,
Medicare is not just for sick days! Did you know you could use your Medicare coverage for annual wellness exams, like check-ins with your gynecologist or OB/GYN? This post will tell you about all the ways women can use Medicare preventative benefits to stay healthy.
Does Medicare Cover Gynecology?
As long as you have an OB/GYN that accepts Medicare, your Medicare Part B gives you access to preventative women’s health care.
There are no exceptions – every woman enrolled in Medicare Part B has gynecology coverage. You should be taking advantage of these benefits! Remember that your Medicare is designed not just to help you in a time of illness or injury, but also to prevent those illnesses or injuries from occurring.
This coverage can include services like:
- Gynecological & breast exams
- Pap smears
- Cancer screenings
- Menstrual/menopausal management
- Contraception counseling, if relevant
- Treatment for abnormalities and infections
Does Medicare Cover Mammograms?
If you are enrolled in Medicare, your annual mammogram screening is covered 100% so long as your provider accepts Medicare. Diagnostic mammograms are covered at 80%, which leaves you responsible for the remaining 20% ($60 on average). Diagnostic mammograms are used if you have suspicious or concerning results from your annual mammogram.
A Medicare Supplement plan can help cover the additional costs of diagnostic mammograms and other services. Depending on which type of Medicare Supplement plan you purchase, benefits can include:
- Part A coinsurance and hospital costs
- Part B coinsurance and copayments
- Blood work copays (up to three pints)
- Hospice coinsurance and copayments
- Skilled nursing facility coinsurance
- Part A deductible
- Part B deductible
- Part B excess charges
- Foreign emergency travel
These financial benefits can help with any of your health-related costs, not just mammograms. If you would rather pay a small monthly premium to help protect yourself from unforeseen health expenses, a Medicare Supplement plan may be right for you.
Medicare Advantage plans are required to cover, at a minimum, the same as Original Medicare. This means that your annual mammogram is still cost-free to you and diagnostic mammograms are covered at 80%.
However, Medicare Advantage plans can offer several additional benefits beyond Original Medicare that can help you maintain a healthy and proactive lifestyle. These benefits include vision, hearing, and dental coverage, monthly OTC pharmacy allowance, non-emergency transportation, group fitness classes like SilverSneakers®, and so much more! These plans have continued to grow in popularity each year, and more than 20.4 million beneficiaries are taking advantage of these benefits.
Medicare Mammogram Eligibility
To be eligible for preventive mammogram screening coverage, you need to be a woman enrolled in Original Medicare (Part A and B) or a Medicare Advantage plan. Men are not eligible for annual Medicare-covered mammograms. While it is possible for men to get breast cancer, it is very rare. That’s why most men are not eligible for preventive mammograms. However, men who are at high-risk can have diagnostic mammograms covered at 80%, just like women.
How Often Does Medicare Pay for Mammograms?
We know Medicare covers Mammograms, but how many? Medicare will cover one preventive mammogram per year. If your results are concerning or show you have a high risk of developing cancer, Medicare will continue to pay 80% for each diagnostic mammogram needed. There is no limit on how many diagnostic mammograms Medicare will cover.
Does Medicare Cover Gynecological Exams?
Gynecological exams and services covered by Medicare include:
- Gynecological exams
- Breast exams
- Pap smears
- Gynecological cancer screenings
- Testing for HPV, HIV, and other sexually transmitted diseases
- Treatment for pelvic and vaginal infections
- Treatment for abnormal vaginal bleeding
- Contraception counseling
- Menstrual pain and irregularities
- Menopausal management
Does Medicare Cover Pelvic Exams, Pap Smears, and Breast Exams?
Your Medicare gives you access to pelvic exams, pap smears, and breast exams. These tests check for cervical, vaginal, and breast cancer. Coverage is available for pelvic exams and pap smears once every two years. If you’ve had abnormal results in the past three years, you’ll be covered for yearly tests instead.
You’ll also be covered for clinical breast exams. Breast cancer is the most common cancer for women. Risk increases with age, and you can be cured much more easily if it is caught early on. Take advantage of free preventative care!
Additionally, you can ask your doctor for STI (sexually transmitted infection) screenings and counseling. Counseling is recommended for those who are at a higher risk. Part B covers yearly tests for the most common STIs – chlamydia, gonorrhea, syphilis, and hepatitis B, as well as HIV. STI tests are completely free with a doctor who accepts Medicare assignment.
Gynecologists Covered by Medicare
Are you ready to see a gynecologist? The best way to confirm that your gynecologist accepts Medicare as insurance is to ask when you set your first appointment, but there are tools you can use to find out who accepts Medicare before you start calling around.
Remember that if you have a Medicare Advantage or Medicare Supplement plan, you may want to check to make sure that the doctor accepts your plan. If you only have Original Medicare (parts A and B), you can use the Medicare.gov physician finder tool to look for gynecologists in your area who accept Medicare.
To start, enter your location and the phrase “gynecologist” or “ob/gyn” in the search bar. The tool will not let you enter the type of doctor you’re looking for until you’ve entered your location.
After clicking the green “search” button, you’ll see a list of doctors in your area who accept Medicare for gynecology. The tool will tell you where they are located, how far they are from the location you entered, etc.
Get Women’s Health Coverage
Fortunately, Original Medicare covers most women’s health needs. However, Medicare Advantage and Medicare Supplements can supplement your Original Medicare coverage. If you are looking for additional health benefits through Medicare Advantage or financial benefits through Medicare Supplements, our licensed agents can help. They are contracted with all the major carriers so they can enroll you in a plan without bias. With Medicare Plan Finder, there’s never an obligation to enroll and appointments are always cost-free to you. Fill out this form or give us a call at 844-431-1832.
This blog was originally published on July 20, 2017 and last updated on October 3, 2019 by Anastasia Iliou.
