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Does Medicare Cover Annual Gyn Exam

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Is The Medicare Wellness Exam Free

Medicare & You: Women’s health

Yes, the Medicare annual wellness exam is a Medicare-covered service as long as your primary care doctor accepts Medicare. It wont cost you anything unless your doctor performs additional tests or services during the same exam. If they do, you may owe a coinsurance or copayment depending on the service provided.

What Does An Annual Exam Include

Preventive Medicine Service codes are defined by the CPT book as evaluation or reevaluation and management of an individual, including an age- and gender-appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures.

The purpose of the annual exam includes screening for disease, assessing risk of future medical problems, promoting a healthy lifestyle, and updating vaccinations. Aspects of the annual exam may include all or some of the following:

1. Review of History11. Males: Testicular and Prostate Exams12. Females: Breast and Pelvic Exams13. Counseling15. Immunizations

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On This Page

  • Medicare Part B covers pelvic exams, pap smears, and breast exams, usually once every 24 months
  • Gynecologists suggest that women over 65 should still get pelvic exams and pap smears to protect their health
  • A Medicare Advantage plan might offer additional coverage over Original Medicare

Gynecological exams are of paramount importance when it comes to womens health. Pap smears and breast examinations help detect early signs of cancer, as well as a host of other reproductive issues.

Health insurance pays for the majority of gynecological services you might need.

However, some women wonder if Medicare covers gynecological services. If youve been wondering, Does Medicare cover gynecology exams? the answer is yes, regardless of your age. However, Medicare doesnt cover all gynecological services.

  • Find the Best Medicare Health Insurance for Gynecologist Exams
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    Medicare Coverage For Initial Physical

    A person is eligible for one initial preventive physical examination , also known as a Welcome to Medicare physical exam, within the first 12 months of enrolling in Medicare Part B.

    Medicare enrollment typically begins when a person turns 65 years old. People may qualify at an earlier age if they have specific disabilities or health conditions, according to the Centers for Medicare & Medicaid Services .

    Some of the tests that the IPPE includes are:

    • medical history reviews
    • preventive services education
    • social health history reviews

    This medical exam is free, as long as the healthcare professional performing the exam accepts the assignment. This means that they:

    • accept payment directly from Medicare
    • agree to receive no more compensation than the Medicare preapproved amount
    • agree not to bill a person for any more than the deductible and coinsurance

    Medicare Part B also covers annual wellness visits at no extra cost, providing the medical professional accepts the assignment.

    According to CMS, the following are the types of healthcare professionals who can perform an AWV:

    • physician or doctor
    • nurse practitioner, certified clinical nurse specialist, or physician assistant
    • health educator, registered dietitian, or other health professionals whom a doctor directly supervises

    Medicare covers an AWV once every 12 months. The services that a doctor may perform include:

    • setting up a personal prevention plan
    • completing a health risk assessment
    • updating a personalized protection plan

    Get Womens Health Coverage


    Fortunately, Original Medicare covers most womens health needs. However, Medicare Advantage and Medicare Supplements can supplement your Original Medicare coverage. If you are looking for additional health benefits through Medicare Advantage or financial benefits through Medicare Supplements, our licensed agents can help. They are contracted with all the major carriers so they can enroll you in a plan without bias. With Medicare Plan Finder, theres never an obligation to enroll and appointments are always cost-free to you. Fill out this form or give us a call at 833-438-3676.

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    How Medicare Helps Cover Gynecological Care

    You can also opt to have the gynecological portions of your Wellness exam performed by your gynecologist rather than your primary doctor. You will just need to make sure that your doctor marks them as deferred during your regular Wellness exam.

    If you have an abnormal Pap smear or are at risk of cervical or vaginal cancer, Medicare will cover a gynecological exam once every 12 months.

    If you see an in-network provider for these exams, you do not pay any out-of-pocket expenses, including your health care deductible and copayment or coinsurance. However, if your doctor begins diagnostic testing for symptoms that are noticed during your exam, you may have to pay your deductible and copayment or coinsurance for the tests.

    Medicare Coverage For Preventive Screenings For Females

    Medicare covers Pap smears, pelvic exams, STI testing and HPV screenings. Clinical breast exams are also covered.

    How often you can receive these preventive services depends on your medical history and any risk factors.

    Cervical cancer and other cancers of the female reproductive organs often have no symptoms.

    According to Johns Hopkins University, cervical cancer is more likely to be successfully treated if it is found early.

    Screening tests such as Pap smears and pelvic exams can help find abnormal cells that may lead to cancer.

    How Often You Can Get a Pap Smear and Pelvic Exam with Medicare


    Certain risk factors may qualify you to receive Pap tests and pelvic exams more frequently than once every 24 months.

    High risk factors for cervical and vaginal cancer include:

    • Early onset of sexual activity
    • More than five sexual partners in a lifetime
    • History of sexually transmitted disease
    • Fewer than three negative Pap smears within the previous seven years
    • Daughters of women who took DES during pregnancy

    For Medicare to pay your claim, Pap smears and pelvic exams must be ordered and performed by a doctor, certified nurse-midwife, physician assistant, nurse practitioner or clinical nurse specialist.

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    Whats The Difference Between A Medicare Annual Wellness Exam And The Initial Preventive Physical Exam

    The Initial Preventive Physical Exam is a one-time exam also focused on preventable health diseases that occurs within the first 12 months of your Medicare Part B coverage.

    Many of the services you receive during the Welcome to Medicare visit are the same as ones you get during the annual wellness exam , and like the wellness exam, there is no cost to you if your doctor accepts Medicare.

    Cervical & Vaginal Cancer Screenings

    Annual Wellness Visits (AWV) Video

    Medicare Part B covers Pap tests and pelvic exams to check for cervical and vaginal cancers. As part of the pelvic exam, Medicare also covers a clinical breast exam to check for breast cancer. Medicare covers these screening tests once every 24 months in most cases. If youre at high risk for cervical or vaginal cancer, or if youre of child-bearing age and had an abnormal Pap test in the past 36 months, Medicare covers these screening tests once every 12 months.

    Part B also covers Human Papillomavirus tests once every 5 years if youre age 30-65 without HPV symptoms.

    If your doctor or other qualified health care provider accepts assignment, you pay nothing for the following:

    • the lab Pap test
    • the lab HPV with Pap test
    • the Pap test specimen collection
    • the pelvic and breast exams

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    Does Medicare Cover An Annual Pap Smear

    Medicare Part B covers a Pap smear once every 24 months. The test may be covered once every 12 months for women at high risk. Your doctor will usually do a pelvic exam and a breast exam at the same time. These screenings are also covered by Part B on the same schedule as a Pap smear.

    You pay nothing for a Pap smear, pelvic exam or breast exam as long as your doctor accepts Medicare assignment. If your doctor recommends more frequent tests or additional services, you may have copays or other out-of-pocket costs.

    Medicare Advantage plans cover Pap smears as well. Just make sure your doctor or other provider is in the plan network.

    A regular Pap smear is one of several preventive services that Medicare covers. Ensuring youre up to date on this and other important screening tests is one very good reason you should schedule an annual Medicare Wellness Visit.


    Understanding Why Medicare Does Not Pay For Annual Physical Exams

    Now that weve summarized the different services provided during these annual exams and visits, we can examine why Medicare only covers annual wellness visits and not annual physical exams.

    The reason becomes more apparent when we simplify the differences between an annual physical exam and an annual wellness visit. As the KHN article referenced earlier states, An annual physical typically involves an exam by a doctor along with bloodwork or other tests. The annual wellness visit generally doesnt include a physical exam, except to check routine measurements such as height, weight and blood pressure. The UNC School of Medicine notes, Medicare wellness visits are designed to improve your overall health care by providing a more detailed look at your health risks based on family history and health behaviors and more.

    Think of the annual physical exam as more of a hands-on experience, whereas the annual wellness visit takes a hands-off approach to evaluation. It would seem that when the federal government was debating what to cover within traditional Medicare, the decision was to cover the broader look at a beneficiarys health. In discussing the annual wellness visits, AARP states, The visit provides a snapshot of your current health as a baseline for future yearly visits, and is intended as a preventive service a way of catching potentially serious health issues early.

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    Does Medicare Cover Pap Smears After 65

    Medicare is government-funded health insurance for adults aged 65 and older and those with certain disabilities. Since most Medicare beneficiaries are above the age of 65, Medicare does continue to cover Pap smears after this age. Medicare Part B will continue to pay for these Pap smears after the age of 65 for as long as your doctor recommends them.

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    Medicare will also cover an HPV test every five years for those between the ages of 30 and 65. This is included in your Pap smear test.

    If you are between the ages of 35 and 39, Medicare will cover a screening mammogram one time, and then every 12 months after the age of 40.

    The same expense rules apply to these tests: you will not have to pay any out-of-pocket expenses as long as you choose an in-network provider that accepts assignment.

    If you need a diagnostic mammogram rather than a screening mammogram, you may need to pay your deductible and copayment or coinsurance. However, Medicare may cover them more frequently than every 12 months.

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    Document Code And Bill Correctly

    Once the service is delivered, proper documentation is key. Providers should ensure they document the correct service that’s being delivered, without any ambiguity. This will help ensure the service is coded correctly, which should then allow billers to bill the correct insurance and collect the appropriate amount from patients.

    Education is critical to completing these steps consistently and adequately. Staff should be trained on the differences between a Medicare annual wellness visit vs. annual physical exam vs. IPPE and why those differences matter from a coding, billing, and reimbursement perspective. Consider creating a cheat sheet to help remind staff of the differences when they are completing documentation.

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    Its an opportunity for you and your primary care doctor to touch base about preventable health diseases and keep you on the right track toward living a healthy and active lifestyle.

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    Is A Pelvic Exam Necessary After 65

    In addition, according to the CDC, most breast cancer cases are diagnosed after age 50. Since Medicare covers a breast exam in addition to a pelvic exam, it is vital to make sure that you are undergoing regular breast exams with your doctor after the age of 65.

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    Is A Pap Smear Necessary After Age 65

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    Pap smears are an essential part of screening for cervical and vaginal cancers, even in older adults. Even after you turn 65, you may still be at risk of developing cervical cancer or vaginal cancer, so it is recommended to continue taking Pap tests until your doctor says to stop. According to the Centers for Disease Control & Prevention , you no longer need to have Pap smears after the age of 65 if:

    • you have had three normal Pap smears in a row within the previous 10 years.
    • you have had two normal Pap-HPV co-tests in a row within the previous 10 years.

    Screening for cervical and vaginal cancers should continue after 65 years of age for high-risk women, which includes those who:

    • have a history of cervical cancer or lesions.
    • are the child of a mother who was given DES during pregnancy.
    • have weakened immune systems.

    Talk with your provider to learn more about how often you are covered for Pap smear tests.

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    Macular Degeneration Tests And Treatment

    Macular degeneration is a condition that causes loss of vision that helpsyou to see objects in front of you. This can affect activities like driving andreading.

    Medicare may cover some diagnostic tests and treatments if you have macular degeneration thats related to aging. This can also include things like some types of injected drugs.

    How To Prepare For Annual Gynecological Exam

    The first thing you need to do is to relax. Gynecologists do these types of tests on a daily basis, and theyve heard every story under the sun. We are not here to judge you or make you feel vulnerable. There is nothing you can say that theyll consider weird or unusual. Although that can sometimes be easier said than done, once you get the appointment over with, youll see that it sounds a lot scarier in your mind than what it actually it is in reality.

    Also, keep the following pointers in mind:

    Take notes of everything you may want to discuss: Whether youre considering having sex for the first time, whether youre already having sex, information about your partners, whether you use birth control, whether you use protection against sexually transmitted diseases, whether youve noticed any changes in your period, have experienced pain or irritation, or whether there are any changes in your vaginal discharge.

    Schedule the appointment for a time when you wont be on your period. Although its really not that big of a deal if you are, itll make you feel more at ease during your first visit.

    Drink liquids before your appointment, since youll have to pee in a cup before your exam.

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    Does Medicare Cover Annual Gynecological Exams

    Medicare covers medical procedures and treatments that are medically necessary for your health. Since gynecological exams are vital in the detection of life-threatening health conditions, they fall under Medicare coverage.

    Pap smears, pelvic exams, and breast exams are crucial in detecting breast and cervical cancer. Additionally, pelvic exams check for:

    • Other abnormalities

    Women usually get a Health insurance and pap smear annually or biannually. However, if you are experiencing pain, have unusual discharge or bleeding, or have urinary issues, your gynecologist will want to do an exam.

    Medicare does cover gynecology exams through Part B. Part B covers outpatient services like doctor appointments, preventative health services, and diagnostic tests.

    However, if you need more gynecological care than Medicare will cover, you can purchase supplemental insurance, known as Medigap.

    Does Medicare Cover Pelvic Exams Pap Smears And Breast Exams

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    Your Medicare gives you access to pelvic exams, pap smears, and breast exams. These tests check for cervical, vaginal, and breast cancer. Coverage is available for pelvic exams and pap smears once every two years. If youve had abnormal results in the past three years, youll be covered for yearly tests instead.

    Youll also be covered for clinical breast exams. Breast cancer is the most common cancer for women. Risk increases with age, and you can be cured much more easily if it is caught early on. Take advantage of free preventative care!

    Additionally, you can ask your doctor for STI screenings and counseling. Counseling is recommended for those who are at a higher risk. Part B covers yearly tests for the most common STIs chlamydia, gonorrhea, syphilis, and hepatitis B, as well as HIV. STI tests are completely free with a doctor who accepts Medicare assignment.

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    Does Medicare Require A Wellness Exam

    Medicare does not require a wellness exam however, its still important to take advantage of this important benefit. Thats because the wellness exam gives you an opportunity to get personalized health advice.

    You can talk about any healthcare concerns you may have, ask questions about your medications, talk about changes to your diet or exercise routine and more.

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