Pap smears can provide early detection for cervical or vaginal cancer and screen for sexually transmitted infections (STIs), fibroids, and other types of vaginal problems.
The short answer to the question of whether or not Medicare pays for Pap smears after 65 is “yes.”
Medicare pays for Pap smears for as long as you and your doctor determine that they are necessary, even after age 65. Medicare Part B covers Pap tests and pelvic exams to check for cervical and vaginal cancers and clinical breast exams, including breast cancer screenings. This laboratory test consists of a health care provider taking a sample of cervical cells for interpretation.
However, there are several things you should know regarding coverage.
Medicare Part B covers Pap tests and pelvic/clinical breast exams for all female patients when ordered and performed by the following medical professionals:
Typically, Medicare covers these screening tests once every 24 months. However, you may be eligible for these screenings every 12 months if you are at high risk for cervical or vaginal cancer or are of childbearing age and have had an abnormal Pap smear in the past 36 months. A woman of childbearing age is defined as a premenopausal female, and a qualified medical practitioner determines she is of childbearing age based on medical history or other findings.
Medicare may consider you at high risk for cervical or vaginal cancer if you:
Medicare Part B also covers Human Papillomavirus (HPV) tests as part of a Pap test smear once every five years if you are between 30-65 without HPV symptoms. An HPV screening detects the virus that can cause cervical cancer and warts.
Pap smears, pelvic exams, STI, and HPV screenings are similar services, but Medicare considers them separate benefits.
According to the Centers for Disease Control & Prevention (CDC), you no longer need to have Pap smears after the age of 65 if:
If you are over 65 and no longer need Pap smears, pelvic exams remain an important screening tool for older women, especially those still sexually active. Because most breast cancer cases are diagnosed after age 50 and Medicare covers a breast exam in addition to a pelvic exam, regular breast exams after age 65 are encouraged.
Unfortunately, Medicare does not cover HPV testing for beneficiaries above age 65.
You pay nothing for the lab Pap test, the lab HPV with Pap test, the Pap test specimen collection, and the pelvic and breast exams if your doctor or other qualified health care provider accepts
assignment.
If a patient sees a participating Medicare provider, original Medicare waives the coinsurance or copayment and Medicare Part B deductible for a screening Pap test, pelvic exam, and HPV screening when all other coverage conditions are met.
Your health care provider may recommend you get services more often than Medicare covers or recommend services that Medicare doesn’t cover. For example, your provider may discover the need to investigate or treat a new or existing problem during your screenings. This additional care is diagnostic because your provider is treating you due to specific symptoms or risk factors. In this case, Medicare may bill you for any diagnostic care you receive during a preventive visit.
You could be denied coverage for screening Pap tests, pelvic exams, and HPV screenings in several situations, including:
One final note: Medicare Advantage Plans must cover these screenings without applying deductibles, copayments, or coinsurance when you see an in-network provider and meet Medicare’s eligibility requirements for the service.
DISCLAIMER: Medi-Solutions Insurance Agency, LLC is not affiliated or endorsed with the Social Security Administration or the Federal Medicare Program. Information is for educational purposes only and should not be construed as an offer of insurance, advice, or recommendation. The information provided is not intended as tax, financial, investment, or legal advice. Please consult legal or tax professionals for specific information regarding your individual situation.
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