Medicare Pap Smear Coverage After Age 70 Explained

For many women over the age of 70, the question of whether to continue getting regular Pap smears is intertwined with a more practical concern: will Medicare pay for it? The good news is that Medicare Part B provides coverage for cervical and vaginal cancer screenings, including Pap tests and pelvic exams, for all eligible beneficiaries, regardless of age. This coverage is a critical component of preventive health for senior women, as the risk for certain cancers persists later in life. Understanding the specifics of this coverage, including frequency, costs, and the important distinction between screening and diagnostic tests, is essential for making informed healthcare decisions and avoiding unexpected bills.

Medicare’s Coverage for Preventive Screenings

Medicare Part B is the segment of Original Medicare that covers outpatient services, including doctor visits and preventive care. Under this umbrella, Medicare covers a wide range of preventive services designed to detect illnesses early, when they are most treatable. Cervical and vaginal cancer screenings are among these covered services. Medicare will cover a screening Pap test and a clinical pelvic exam once every 24 months for all women who are at average risk for cervical or vaginal cancer. For women who are at high risk, or for those who had an abnormal Pap test in the past 36 months, Medicare will cover these screenings once every 12 months. It is crucial to understand that “coverage” does not always mean “free.” While Medicare covers the bulk of the cost for these preventive services when performed by a participating provider, there may still be out-of-pocket costs for the beneficiary.

The standard cost-sharing structure for Medicare Part B applies to Pap smears. After you meet your annual Part B deductible, which changes yearly, Medicare typically pays 80% of the Medicare-approved amount for the screening. You are responsible for the remaining 20% coinsurance. However, there is a significant financial benefit if your doctor accepts Medicare assignment. In this case, they agree to charge no more than the Medicare-approved amount, and your 20% share will be based on that lower figure. If your provider does not accept assignment, you could be billed for up to 15% more than the approved amount, in addition to your standard coinsurance. This is why seeing a Medicare-participating provider is always the most cost-effective choice. For a deeper look at how Medicare cost-sharing works and how to budget for it, our resource on whether Medicare costs go up every year offers valuable planning insights.

Pap Smears After 70: Medical Guidelines and Personal Choice

The decision to continue Pap smears after age 70 is not solely a financial one, it is also a medical and personal one. For decades, the age of 65 or 70 was seen as a clear stopping point for cervical cancer screening. However, medical understanding has evolved. The U.S. Preventive Services Task Force (USPSTF) currently recommends discontinuing screening for cervical cancer in women over age 65 who have had adequate prior screening and are not otherwise at high risk. “Adequate prior screening” is generally defined as three consecutive negative Pap tests or two consecutive negative HPV tests within the 10 years before stopping, with the most recent test performed within 5 years of discontinuation.

This recommendation exists because cervical cancer is typically very slow-growing, caused by persistent HPV infection acquired years earlier. If a woman has a history of normal screenings, her risk is considered very low. However, these are guidelines, not absolute rules. Many healthcare providers advise continuing screening beyond 70 for women with certain risk factors, or for those whose screening history is unknown or incomplete. Key risk factors that may justify continued screening include a history of cervical cancer or precancerous lesions (CIN 2 or higher), exposure to diethylstilbestrol (DES) before birth, or a compromised immune system (e.g., from an organ transplant or HIV). The decision should be a shared one between a woman and her doctor, based on her complete health history and personal risk profile. It is a conversation worth having during your annual wellness visit.

Navigating Costs and Billing with Medicare

To ensure your Pap smear is covered correctly, it is vital to understand how Medicare categorizes the service. Medicare makes a clear distinction between a “screening” Pap smear and a “diagnostic” one. A screening test is performed when you have no symptoms or abnormalities, purely as a preventive measure. This is the service covered under the every-24-month schedule with the standard cost-sharing. A diagnostic Pap test, however, is performed because you have symptoms (like abnormal bleeding) or because a previous screening test was abnormal. Diagnostic tests are still covered by Medicare, but they are billed differently and are subject to your standard Part B deductible and coinsurance without the preventive service benefit schedule.

This distinction can significantly impact your out-of-pocket costs. If you go in for a routine screening but mention a symptom to your doctor, the entire visit and test may be coded as diagnostic. To avoid confusion and potential higher bills, communicate clearly with your doctor’s office about the purpose of your visit. When scheduling, state that you are coming in for your “Medicare-covered preventive Pap smear and pelvic exam.” During the visit, if you need to discuss a specific symptom or problem, ask if it can be addressed in a separate, distinct part of the visit. Always review your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB) from your Medicare Advantage plan to verify how the service was billed. Understanding your coverage details is as important as knowing whether Medicare automatically renews each year, as both affect your ongoing care planning.

What Medicare Advantage Plans Cover

If you are enrolled in a Medicare Advantage (Part C) plan, your coverage for Pap smears is at least as good as Original Medicare’s coverage. By law, Medicare Advantage plans must cover all the same preventive services that Original Medicare covers, often with $0 copays. Many plans enhance this benefit by offering $0 copays for in-network preventive screenings, including Pap tests and pelvic exams. This can make the service completely free at the point of care, which is a significant advantage.

However, the rules about network providers become paramount. You must use doctors and labs within your plan’s network to receive the highest level of coverage and the lowest copays. Going outside the network can result in much higher costs or no coverage at all. Always check your plan’s Evidence of Coverage document or call member services to confirm your specific benefits, network rules, and whether a referral is needed. It is also wise to confirm that your gynecologist or primary care physician is still in the plan’s network during the Annual Election Period, as networks can change. For a comprehensive look at how these plans handle other specific services, you can explore our article on Medicare Advantage hospice coverage to see how benefits are structured for different types of care.

Frequently Asked Questions

Does Medicare cover the HPV test along with the Pap smear? Yes, Medicare Part B covers a screening HPV test once every five years when performed alone or in conjunction with a Pap test for women aged 30 to 65. For women over 65, coverage for the HPV test is generally limited to those who are at high risk or who have an abnormal Pap result. Your doctor can advise if this co-testing is appropriate for you.

I had a hysterectomy. Will Medicare still cover a Pap smear? It depends on the type of hysterectomy. If you had a total hysterectomy (removal of both the uterus and cervix) and have no history of cervical cancer or precancerous lesions, Medicare will not cover a screening Pap smear, as you no longer have a cervix to screen. If you had a partial hysterectomy (uterus removed but cervix remains), or if you have a history of cervical cancer/DES exposure, coverage may still apply. A diagnostic Pap of the vagina may be covered if medically necessary.

Are there any other costs associated with the screening visit? Possibly. While the Pap smear and pelvic exam themselves are covered under preventive benefits, if your doctor performs additional services or tests during the same visit that are not considered part of the standard screening, you may be charged for them. This could include blood work, a urinalysis, or discussing and treating a new health problem. These would be billed separately under your standard Part B benefits.

What if I need a follow-up procedure like a colposcopy? If your Pap smear results are abnormal and your doctor recommends a colposcopy (a procedure to closely examine the cervix), Medicare will cover it as a diagnostic procedure. You will be responsible for the Part B deductible (if not already met) and the 20% coinsurance. This is a critical example of why preventive screening is valuable, it can lead to early diagnostic care that is also covered, as detailed in our guide on Medicare coverage for necessary procedures like tooth extractions, which follows a similar diagnostic coverage model.

Navigating Medicare coverage for preventive care like Pap smears after 70 empowers you to take charge of your health without financial surprise. By understanding the guidelines, discussing your personal risk with your doctor, and confirming how your specific Medicare plan covers the service, you can make confident decisions that support your long-term well-being. Regular communication with your healthcare provider is the cornerstone of effective preventive care at any age.