Does Medicare Cover Pap Smears?
Last Updated : 09/10/20184 min read
According to the American Cancer Society, women age 21 to 29 should have a Pap smear test to screen for cervical cancer every three years. Women age 30 to age 65 should have a Pap smear test combined with an HPV test every five years.
Women over 65 and women who have had a total hysterectomy (removal of the uterus and cervix) may be able to stop having Pap smear tests. If you’ve received an abnormal result, your doctor may recommend you get a Pap smear more frequently.
What is a Pap smear?
Your Medicare coverage may pay for the cost of a Pap smear. The primary goal of a Pap smear test is to screen for signs of cervical cancer. During the Pap smear test, your doctor uses a small spatula-shaped device to scrape a few cells from your cervix. The doctor then sends the cells to a laboratory to check for “pre-cancers” or cell abnormalities that can cause cervical cancer.
Cervical cancer can be fatal, but according to the Centers for Disease Control (CDC), it is also one of the easiest to identify through a routine Pap smear. The American Cancer Society estimates that approximately 13,000 women will be diagnosed with cervical cancer this year, and about 15% of them will be women over age 65. Pap smears may help your doctor identify pre-cancerous cells and treat you before the cancer fully develops.
Does Medicare coverage pay for a Pap smear?
Original Medicare provides your health-care coverage in two parts: Medicare Part A provides hospital coverage for inpatient hospital and skilled nursing facility treatment, while Medicare Part B is medical insurance, including doctor visits and preventive care like Pap smears.
Medicare Part B covers Pap smears and pelvic exams to screen for cervical and vaginal cancer. In addition, part of this screening includes a clinical breast exam to screen for breast cancer. All women with Medicare Part B are covered for these three screenings once every 24 months.
You may be covered for a Pap smear once every 12 months if:
- You’re considered high risk for cervical or vaginal cancer, or
- You’re of childbearing age and have had an abnormal Pap smear test result in the last 36 months.
Medicare Advantage plans offer you at least the same level of coverage as Original Medicare (except for hospice care, which is still covered through Part A), meaning that Pap smear tests are also covered. The primary difference with Medicare Advantage is that you get Medicare benefits from a Medicare-approved private insurance company instead of directly through the government. Some Medicare Advantage plans include extra benefits such as prescription drug coverage.
What are my costs for a Pap smear test under Medicare coverage?
When you schedule an appointment for a Pap smear, your doctor may also schedule you to receive a pelvic and breast exam, so that he or she can screen you for cervical, vaginal, and breast cancer.
Your costs depend on whether you meet eligibility requirements and are getting the screenings such as Pap smears during the time frame that Medicare covers the screenings, based on your risk factors. Remember, you’re covered once every two years or once every year if you’re at increased risk for cervical or vaginal cancer (see above for more information on eligibility). If you meet the eligibility criteria for the screening, the lab Pap smear test is free. The Pap smear test specimen collection, pelvic exam, and breast exam are also free if you get them through a doctor or other health-care provider that accepts assignment.
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For more information on prevention of cervical cancer, see:
Centers for Disease Control and Prevention, “What are the risk factors for cervical cancer?” last updated May 6, 2014.
Centers for Disease Control and Prevention, “Gynecologic Cancers: What Should I Know About Screening?” last updated March 29, 2016.