Regular pelvic exams are a woman’s first line of defense against cancer, uterine fibroids, and ovarian tumors. Accordingly, women who receive Medicare benefits need to understand how their coverage will help them get the pelvic exams, pap smears, and other screenings they need to stay healthy.

What is a Pelvic Exam?

A pelvic exam involves a physical examination of the reproductive organs, including the vagina, vulva, cervix, ovaries, uterus, rectum and pelvis. During a pelvic exam, your doctor may check for abnormalities, perform a Pap and/or HPV test, and review your medical history. A Pap test involves scraping a few cells from the inside of your cervix to be examined under a microscope for signs of cancer. During the well woman’s exam, you may also receive a clinical breast exam to screen for breast cancer. Early detection and treatment of certain cancers can affect the long-term outcome, so routine exams and screenings are extremely important.

Pelvic Exams Covered Under Part B

Individuals 65 years of age and older are eligible for Medicare, but you may qualify under the age of 65 if you have certain disabilities. Most people qualify for premium-free Part A (Hospital Insurance), but most choose to enroll in optional Part B (Medical Insurance) when they are first eligible to avoid late enrollment penalties. While Part A helps cover the expenses incurred when you are formally admitted into the hospital, Part B includes coverage of medically necessary services and preventive care, including pelvic exams and Pap smears to test for vaginal and cervical cancers.

When you become eligible for Medicare benefits, you will receive a “Welcome to Medicare” visit. During this appointment, your physician will assess your current health, review your health history, and determine a schedule for preventive screenings, including pelvic exams. If you’ve had Medicare for more than 12 months, you are eligible for a Yearly Wellness visit once every 12 months. You pay nothing for these preventive visits and the Part B deductible does not apply.

Medicare Part B covers a pelvic exam and cancer screenings once every 24 months. If you are considered high risk for cervical or vaginal cancer, or if you are of child-bearing age, Medicare will cover these exams once every 12 months. You could fall into the high-risk category if you:

  • Are of childbearing age and have had an abnormal pap smear within the past three years
  • Became sexually active at an early age (prior to age 16)
  • Have had more than four sex partners during your lifetime
  • Currently have or have had a sexually-transmitted disease

Part B will also cover Human Papillomavirus (HPV) tests once every 5 years if you are between the ages of 30-65 without HPV symptoms. You will pay nothing for pelvic exams, breast exams and screenings as long as you visit a physician or qualified health care provider who is approved by Medicare and accepts assignment. The Part B deductible does not apply.

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