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
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.