Does Medicare Cover Pelvic Exam?

Pamela Cannaday by Pamela Cannaday | Licensed since 2011
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This article was updated on: 10/20/2018

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If you’re a woman enrolled in Medicare Part B, a pelvic exam may be covered. Here’s what you should know about pelvic exam and your Medicare benefits.

Does Medicare Cover Pelvic Exam?

If your doctor’s office has scheduled you for a pelvic exam, learn about what it is and whether Medicare may cover it.

What is a pelvic exam?

According to the National Institutes of Health (NIH), a pelvic exam is a physical examination of the pelvic area. This area includes female organs such as the vagina, cervix (opening of the womb), and ovaries, as well as the rectum.

Your doctor may use a pelvic exam to look for signs of vaginal or cervical cancer.

He or she may administer a Pap test, which is a screening test for cervical cancer, according to the NIH.

When might Medicare cover a pelvic exam?

In some cases, Medicare might cover a pelvic exam. Original Medicare is the government health insurance program for people aged 65 and over, or those under 65 who qualify due to disability or illness. Original Medicare generally includes:

  • Part A (hospital insurance), which usually covers the care you receive as an inpatient in the hospital; it may also cover any hospice care you may need. You may need to pay a coinsurance, copayment, and/or deductible; read about your Original Medicare costs.
  • Part B (medical insurance), which generally covers your doctor visits, tests, supplies, and most preventive health services. Part B also comes with a deductible, along with a coinsurance amount for many services and items.

Medicare Part B may cover pelvic exams and Pap tests:

  • Once every two years for all female beneficiaries
  • Once every 12 months for women who are at high risk of developing vaginal or cervical cancer, or who are of childbearing age and have had an abnormal Pap test result within the past three years

How does Medicare cover a pelvic exam?

If your doctor accepts Medicare assignment, you typically pay nothing for the pelvic exam and Pap test under your Part B benefits; your Part B deductible does not apply, because these screenings are considered preventive care.

If your doctor recommends pelvic exams more often than the approved Medicare schedule, you may have to pay some or all of the costs associated with the exam.

In most cases, you may choose to get your Original Medicare benefits through the Medicare Advantage program (Medicare Part C). These plans, by law, must cover all the same care and treatment as Original Medicare (except for hospice care, which is still covered under Part A), so they cover pelvic exams as described above. They may also provide additional coverage for services Original Medicare doesn’t pay for. Most Medicare Advantage plans, for example, include prescription drug coverage. You will need to continue paying your Part B premium, along with any premium your Medicare Advantage plan charges, if you choose this option.

If you have questions about pelvic exams and routine cancer screenings under Medicare, I’d be happy to find answers for you. You can schedule a phone call or request information in a personal email by clicking one of the buttons below. To find out more about plans in your area that you may qualify for, click the “Compare plans” link.

 

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