Gynecology is the branch of medicine that includes diseases and functions specific to women’s health, including the reproductive system. While many women on Medicare are over the age of 65 and past their reproductive years, others receive benefits under the age of 65 due to certain disabilities. Regardless of your age, access to preventive care, routine checkups, screenings and exams are vital to your overall health and well-being.
Gynecological services include a wide range of care, including:
- Gynecological exams
- Breast exams
- Pap smears
- Gynecological cancer screenings (including cervical, uterine, endometrial, and ovarian)
- 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
How Medicare Helps Cover Gynecological Care
Medicare’s Part B (Medical Insurance) coverage for a yearly Wellness Visit includes the components of a Well Woman Exam, which includes a clinical breast exam, Pap tests, and pelvic exam. These exams can be performed by your primary care physician or separately by a gynecologist. During your annual Wellness visit, your primary physician must document that your breast and pelvic exams are being deferred if you choose to have them performed by your gynecologist.
Medicare covers these exams once every 24 months. If you are considered high risk for cervical or vaginal cancer due to abnormal Pap tests in the last 36 months, Medicare will cover the exams once every 12 months. What makes you high risk?
- Personal health history
- History of a sexually transmitted disease
- Fewer than three negative Pap tests in the last seven years
Medicare Part B covers HPV (Human Papillomavirus) tests as part of a Pap test once every five years if you are between the ages of 30 and 65 without HPV symptoms. Part B also covers one baseline mammogram between the ages of 35 and 39. If you are 40 years of age or older, Medicare will cover a screening mammogram every 12 months. If medically necessary, diagnostic mammograms may be covered more frequently.
You will pay nothing for these lab tests, pelvic and breast exams as long as you go to a doctor who accepts assignment. You will pay nothing for screening mammograms if your medical provider accepts assignment. When a doctor accepts assignment, they agree to be paid directly by Medicare, to accept the the payment amount approved by Medicare, and not to bill you for more than the Medicare deductible and coinsurance. If your doctor orders a diagnostic mammogram, you will pay 20% of the Medicare-approved amount, and the Part B deductible applies.
If you are enrolled in a Medicare Advantage plan, you will have at least the same Part A and Part B benefits as you would under Original Medicare, but many MA plans offer additional coverage. Check with your MA plan if you have questions regarding your costs for gynecological care.