Does Medicare Cover Gynecology?

Last Updated : 09/10/20183 min read

Gynecology, often grouped with obstetrics, is a branch of medicine that specializes in the diagnosis and treatment of diseases of the female reproductive organs, according to the National Cancer Institute. Gynecology also specializes in other women’s health issues, such as menopause, hormone problems, contraception and infertility. Original Medicare Part B (medical insurance) covers a number of important gynecology services.

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What gynecology services does Medicare cover?

One role of gynecology is to screen for cancer. Pelvic exams and pap tests to check for cervical and vaginal cancer are covered once every 24 months for all women with Medicare Part B, as long as your doctor accepts Medicare. If you’re at high risk for cervical or vaginal cancer or if you’re of childbearing age and had an abnormal Pap test in the past 36 months, you qualify for these gynecology screenings once every 12 months under Medicare.

As part of the gynecology exam, women are also covered for a clinical breast exam to check for breast cancer. In addition, women ages 35 to 39 with Medicare can get one baseline mammogram, and women age 40 and older with Medicare can get a screening mammogram every 12 months. The provider must accept Medicare assignment. If a diagnostic mammogram is required, then you would have to pay 20% of the Medicare-approved amount, and the Part B deductible applies

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Women might also ask their gynecologists about sexually transmitted infections (STI) screenings and counseling, another important part of gynecology. Part B covers tests for chlamydia, gonorrhea, syphilis, and/or hepatitis B once every 12 months or at certain times during pregnancy. Medicare will also cover up to two individual behavioral counseling sessions each year for sexually active adults who are determined by a health-care provider to be at increased risk for STIs. There’s generally no cost for STI screenings or counseling for a Medicare beneficiary as long as the provider accepts Medicare assignment.

Medicare may cover other health issues in the field of gynecology, such as endometriosis, incontinence, uterine fibroids, ovarian cysts, and urinary tract infections.

Want to learn more about how Medicare covers gynecology?

You may able to obtain Medicare coverage beyond the benefits offered by Original Medicare, Part A and Part B through a Medicare Advantage plan. Want to learn more? I can help. Use one of the links below to set up a phone call or get an email with personalized information. Use the Compare Plans buttons on this page.

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