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Medicare pays for many preventive services in order to aid you in staying healthy. Preventative services can find problems early and can help to keep you from getting certain diseases or illnesses. These services include exams, lab tests, and screenings. Two important preventive services for women are the Pap smear (or Pap test) and Pelvic Examination.
What is a Pap Smear?
The Pap smear is a way to examine cells collected from the cervix (the lower, narrow end of the uterus). The purpose of the Pap test is to detect cancer or abnormal cells that may lead to cancer. This test can also find noncancerous conditions, such as infection and inflammation. Most of these cancers of the cervix can be prevented if women have Pap tests regularly.
What is a Pelvic Examination?
A pelvic examination is a complete physical exam of a woman's pelvic organs (vagina, cervix, uterus and ovaries). A pelvic exam helps to discover certain cancers in the early stages, infections, sexually transmitted diseases (STDs), or other reproductive system problems.
Are the Pap Smear and Pelvic Examination Covered by Medicare?
Medicare Part B covers a Pap smear and pelvic exam for women once every 24 months. However, Medicare will cover these every 12 months, if a woman who is of childbearing age has had an abnormal Pap test within the past 36 months. Also, if your doctor determines that you are at high risk for cervical or vaginal cancer, Medicare will cover these procedures every 12 months.
How Do I Qualify? What Will It Cost?
All women with Medicare coverage are qualified to have a screening pap test and pelvic examination.
For Pap test collection and pelvic examination, which takes place in a doctor's office, you pay 20% of the Medicare-approved amount. You do not have to pay for the Part B deductible.
You pay nothing for the Pap lab test, which is sent to another location for the processing of the results.
What Do the Pap Smear Results Mean?
A normal Pap smear means that all the cells in the cervix are normal and healthy.
An abnormal Pap smear can be a sign of a number of changes in the cells of the cervix:
- Inflammation - This can be caused by an infection of the cervix (including a yeast infection), infection with the human papillomavirus
- (HPV), the herpes virus, or many other infections.
- Mildly abnormal cells–These cells are not cancer cells, but may be precancerous (which means they could eventually turn into cancer).
- Moderately to severely abnormal cells – Further evaluation is needed.
All abnormal Pap smears must be discussed with your physician. These results will usually require re-testing. Many times, cell changes in the cervix may go away without treatment. If the Pap test shows other abnormalities, the physician may perform additional procedures.
What is my risk for cervical cancer?
Your risk for this cancer may increase if:
- You have had an abnormal Pap test.
- You have had cervical or vaginal cancer in the past.
- You have a history of sexually transmitted disease (including the human papillomavirus (HPV) and/or HIV infection).
- You began having sex before age 16.
- You have had many sexual partners.
- Your mother took DES (Diethylstilbestrol), a hormonal drug, when she was pregnant with you.
How Do I Find a Professional to do a Pap Test & Pelvic Examination?
Your primary care doctor may be able to perform Pap tests and pelvic exams. Other specially trained health care professionals, such as physician assistants, nurse midwives, and nurse practitioners can also perform these procedures.
If you get your coverage from a Medicare Advantage plan, you may have to use one of the providers that they have on contract.
If you are covered by Original Medicare, do your homework before choosing a provider. Ask the provider/supplier:
- If they are participating providers/suppliers
- If they accept assignment
- To write down what they will charge and how much of it you will have to pay
If your provider/supplier does not accept assignment:
- You may have to pay more than the Medicare approved amount.
- You may have to pay the entire cost of your supplies when you get them.
- You may have to bill Medicare yourself and wait several weeks before you will be reimbursed.
- If the supplier is not enrolled in Medicare, Medicare will not pay the claim.