Medicare Coverage of a Pap Test (Pap "Smear")


What It Is

A Pap test (sometimes called a Pap "smear") for cervical or vaginal cancer, and a related pelvic exam; clinical breast exam usually also included

What's Covered

Medicare Part B covers one Pap test and pelvic exam (and clinical breast exam, if conducted at the same time) for all women every two years.

Medicare Part B covers a Pap test and pelvic exam (and clinical breast exam, if conducted at the same time) once a year for women considered at high risk, based on personal and family medical history, for cervical or vaginal cancer. It also covers a yearly test and exam for women of childbearing age who've had an abnormal Pap test result in the previous 36 months.

If you have a Medicare Part C Medicare Advantage plan: Medicare Part C Medicare Advantage plans, also called Medicare Advantage plans, must cover everything that's included in original Medicare Part A and Part B coverage. But sometimes a Part C plan covers more, with extra services or an expanded amount of coverage. (Co-payments for Part C plans may also be different than those for Part A or Part B.) To find out whether your plan provides extra coverage or requires different co-payments for a Pap test, contact the plan directly.

What Medicare Pays

Laboratory work: Medicare Part B pays the entire amount charged by the laboratory to examine the sample taken during the Pap test.

Exam and sample collection: If a doctor or other healthcare provider performs the pelvic and breast exams and collects the Pap specimen in any setting (such as a doctor's office or clinic) other than a hospital outpatient department, Medicare Part B pays 80 percent of the Medicare-approved amount for the exam. If the exam is performed in a hospital outpatient department, the patient may be responsible for a co-payment to the hospital (above the Medicare-approved amount), in addition to the 20 percent of the Medicare-approved amount that Medicare Part B doesn't pay.

Beginning January 1, 2011, Medicare Part B will pay the full cost of the Medicare-approved amount for the exam, regardless of where it's performed, if the patient is age 65 or over and has had a recent abnormal screening test result.

Important: Regardless of the rules regarding any particular type of care, in order for Medicare Part A, Medicare Part B, or a Medicare Part C plan to provide coverage, the care must meet two basic requirements:

  • The care must be "medically necessary." This means that it must be ordered or prescribed by a licensed physician or other authorized medical provider, and that Medicare (or a Medicare Part C plan) agrees that the care is necessary and proper. For help getting your care covered, see FAQ: How Can I Increase the Odds That Medicare Will Cover My Medical Service?

  • The care must be performed or delivered by a healthcare provider who participates in Medicare.

Was this medicareinformation helpful?

1 Comment So Far. Add Your Wisdom.

about 4 years ago

Pap smear and pelvic exam every 24 months if you are at low risk for cervical cancer. If you are at high risk for cervical cancer, you may have these tests every 12 months. You will pay nothing for the Pap smear lab test. For collecting the Pap smear and the pelvic exam, you pay 20% of the Medicare-approved amount with no Part B deductible. As part of the pelvic exam, Medicare covers a clinical breast exam to check for breast cancer. http://www.womenhealthcenter.net


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